Role of Sonographic Findings in the Diagnosis of Retained Products of Conception

Abstract

Role of Sonographic Findings in the Diagnosis of Retained Products of Conception

Attapol Kerdarunsuksri MD

Department of Obstetrics and Gynecology, Ratchaphiphat Hospital, Bangkok

Objective: To assess the role of transvaginal ultrasonography for the diagnosis of retained products of conception or incomplete abortion after spontaneous abortion.

Study design: Descriptive study (diagnostic test).

Subjects: Fifty five patients who were diagnosed as first-trimester spontaneous abortion at Ratchaphiphat Hospital and underwent transvaginal ultrasonography during June 2008 and May 2009.

Methods: Medical records of all patients with first-trimester spontaneous abortion who underwent transvaginal ultrasonography and were managed according to hospital's clinical practice guideline were reviewed. Diagnostic criteria for retained conceptive products or incomplete abortion included endometrial thickness more than 10 mm., irregular or heterogeneous endometrial echogenicity, or presence of hyperechoic mass. Those who were diagnosed as incomplete abortion from ultrasonography would subsequently have uterine curettage. Those with negative ultrasonography would have follow-up urine pregnancy test performed at 3 weeks after abortion. Ultrasonographic findings of incomplete abortion were compared with the diagnosis of incomplete abortion from pathological reports of trophoblastic tissues or positive urine pregnancy test 3 weeks after abortion.

Main outcome measures: Sensitivity, Specificity, Positive predictive value, Negative predictive value.

Results: Mean age of the patients was 28.1 ± 8.6 years and mean gestational age was 10.7 ± 2.5 weeks. Using the above diagnostic criteria, the sensitivity, specificity, positive predictive value and negative predictive value for the diagnosis of retained conceptive product or incomplete abortion were 100.0%, 80.0%, 85.7% and 100.0% respectively. Considering each criteria; endometrial thickness more than 10 mm., irregular or heterogeneous endometrial echogenicity and presence of hyperechoic mass had the sensitivity of 90.0%, 70.0%, and 43.3% respectively and the specificity of 84.0%, 84.0% and 96.0% respectively.

Conclusion: Transvaginal ultrasonography is a good investigation in the diagnosis of retained conceptive products or incomplete abortion.

Vajira Med J 2009 ; 53 : 219-231