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Retained Products of Conception (RPOC)

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This is a 21-year-old patient who

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presented to the emergency room, soaking

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a pad approximately every one hour.

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She'd had a medically induced abortion

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approximately two weeks prior.

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Bleeding had pretty much stopped until

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it repeated and got very intense.

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So she started with her ultrasound imaging,

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and you can see there's abnormal thickening

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where we expect the endometrial stripe to be.

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And it's very heterogeneous.

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You can see normal, or more normal, occurring

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endometrium up towards the fundus where the

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normal thickness, it's very well defined.

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You can see the interface between

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the endometrium and the myometrium.

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But as you come down here,

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it's much harder to see that.

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You have all of this echogenic material.

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And then we lose the interface,

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particularly right here, almost like

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there's an attachment right there.

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If you sat on this, you could see

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if this is mobile or not to see what

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part of this is blood or how much of

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this is potentially

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retained products of conception.

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You can also do color Doppler flow to

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see if there's vascularity to this.

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If it's all hematoma, there should

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be no color Doppler vascularity.

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Whereas in this case, you can see

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there's not only a lot of vascularity

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internal within it, but almost all of the

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vessels lead to this space right here.

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So scroll through that.

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And that corresponds to this area right

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here where we lost that interface of the

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endometrium and myometrium right here.

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So this is going to be a diagnosed

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residual fetal or placental tissue,

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meaning retained products of conception.

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So these can have a very variable appearance.

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They're usually going to be heterogeneous

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and echogenic, and that's going to be

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the most accurate, but they're not always

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going to be heterogeneously echogenic.

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And again, you do have to remember there's

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going to be blood product in there.

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The patient comes in with vaginal bleeding.

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So you kind of have to almost look around

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that blood product, like the color Doppler to

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help you with that too, because you can see

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what sort of non vascular and sort of ignore

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that part of it and look at the rest of it.

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Most routine products will have vascularity,

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approximately 79% or 80% of them.

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You can also look for thickened stripe has

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been reported of at least 10 millimeters,

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but that's not highly supported.

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And you can imagine if you have a lot of

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blood product in there, you're going to

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have a thickened stripe regardless there.

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So that's kind of a confounders.

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We have a lot of clots.

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It's also important to know

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that there's a significant false

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positive rate with ultrasounds.

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So this diagnosis is not based purely

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off of imaging but is also clinical.

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So the gynecology, our gynecology colleagues

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may end up just watching and waiting on

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some of these if clinically they don't

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think it's necessarily routine products

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to see if it resolves on their own.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Vascular

Uterus

Ultrasound

Idiopathic

Iatrogenic

Gynecologic (GYN)

Body

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