Simon Meltzer

OP12.10: The role of 3-D ultrasound study of the endometrium in differentiating intrauterine versus extrauterine pregnancy

Objectives: To evaluate the outcome of expectant (‘wait and see’) management in women with retained products of conception (RPOC) after delivery. Methods: This is an ongoing prospective observational study conducted at the Acute Gynaecology Unit (AGU). All women who presented with ongoing vaginal bleeding post delivery and underwent a transvaginal scan (TVS) were included in the analysis. The criteria for the ultrasound diagnosis of RPOC were the presence of a focal echogenic material within the endometrial cavity. All clinically stable patients with a suspect of RPOC were offered expectant management with weekly ultrasound follow-up. Follow-up continued until ultrasound resolution of RPOC. Results: 27 post natal women presented to AGU with a history of possible RPOC. Median interval from delivery to consultation was 25 days (IR 12–63). Median age was 25.5 years (IR 21–29). The commonest presenting complaint was vaginal bleeding (78%). 11/27 (41%) women were diagnosed with RPOC on TVS. Median thickness of RPOC at sonography was 18 mm (IR 11–40). 10 women were managed expectantly and one woman chose surgical evacuation. 9/10 (90%) had spontaneous resolution of the RPOC within 25 days. One woman underwent D&C because she developed fever during follow-up. Conclusions: In selected women with RPOC post natally, expectant management is a feasible option. Ultrasound is an essential part of the follow-up for these women.