Management of Retained Products of Conception

Diagnosis

The American College of Radiology recommends transvaginal ultrasound with Doppler imaging as the cornerstone investigation for diagnosing retained products of conception (RPOC), looking for endometrial mass, focal endometrial thickening, or marked diffuse thickening suggestive of RPOC 3, 4
Quantitative serum beta-hCG level is essential to assess for persistent or rising levels, which would indicate retained trophoblastic tissue or, rarely, gestational trophoblastic disease 3, 5, 6
A complete blood count is necessary to assess for anemia from ongoing bleeding and evaluate for leukocytosis suggesting infection 6
Pelvic examination should be performed to assess for cervical dilation, uterine tenderness (suggesting endometritis), and quantify active bleeding 7

The American College of Radiology guidelines indicate that once RPOC is diagnosed, tailored intervention such as curettage is appropriate 1, 2
Repeat surgical evacuation (MVA or dilation and curettage) is the definitive treatment when RPOC is identified with ongoing symptoms 1, 2, 4
Broad-spectrum intravenous antibiotics should be administered if signs of infection (fever, uterine tenderness, elevated white blood cell count) are present 1, 2
Conservative management or uterine artery embolization may be considered if Doppler shows areas of intense myometrial vascularity with peak systolic velocity >83 cm/s, which increases risk of significant hemorrhage 1, 2

Do not delay imaging, as grayscale and Doppler ultrasound are often helpful in distinguishing RPOC from other causes of post-procedure bleeding 3, 4
Do not rely on single beta-hCG measurement, as serial measurements may be needed if initial ultrasound is non-diagnostic, and persistent elevation indicates retained tissue 3, 5, 6
Do not overlook rare diagnoses, such as gestational trophoblastic disease, which can present similarly and requires histopathological confirmation 3