Tohma Yusuf Aytaç, Dilbaz Berna, Evliyaoğlu Özlem, Çoşkun Bora, Çolak Eser, Dilbaz Serdar
Başkent University, Department of Obstetric and Gynecology, Konya, Turkey.
Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
J Obstet Gynaecol Res. 2016 May;42(5):489-95. doi: 10.1111/jog.12944. Epub 2016 Feb 23.
The aim of this study was to evaluate the predictive value of symptomatic evaluation with transvaginal ultrasonographic findings for diagnosis of retained products of conception (RPOC) after voluntary pregnancy termination via manual vacuum aspiration (MVA).
A total of 466 patients with a gestational age < 10 weeks were followed up at the 7th day after MVA of unwanted pregnancies. The patients who had intense or moderate bleeding and other symptoms related to RPOC had a re-evacuation and all the patients were followed up until the next menstruation. Ultrasonographic evaluation was repeated weekly in asymptomatic patients with abnormal ultrasonographic findings (increased endometrial thickness, presence of hyperechogenic, mixed and hypoechogenic material) until a normal endometrial cavity was visualized.
Out of the 466 patients, 15 (3.2%) had symptoms of RPOC at day 7 while the remaining 451 (96.8%) were asymptomatic and 20 (57.9%) had normal ultrasonographic findings. The 15 symptomatic patients (3.2%) had a repeated MVA. Nine of these 15 patients (60%) had endometrial echogenicity with mixed patterns, two (13.3%) had endometrial echogenicity with hyperechoic patterns, and the remaining four (26.7%) had normal endometrial echogenicity at day 7. Histopathologic examination of 12 of these 15 patients (80%) showed chorionic villi while no gestational tissue was noted in the remaining three of these patients. Endometrial thickness ≥ 10 mm on day 7 had 75% sensitivity and 100% specificity for diagnosis of RPOC in symptomatic women. None of the 451 asymptomatic patients developed any symptoms or needed any further intervention.
As abnormal ultrasonographic findings return to normal over time in asymptomatic patients, the diagnosis of RPOC should not be based on ultrasonographic findings.
本研究旨在评估经阴道超声检查结果的症状评估对人工流产术后妊娠物残留（RPOC）诊断的预测价值。
对466例孕周小于10周的患者在人工流产术后第7天进行随访。有严重或中度出血及其他与RPOC相关症状的患者进行再次清宫，所有患者随访至下次月经。对超声检查结果异常（子宫内膜厚度增加、存在高回声、混合回声和低回声物质）的无症状患者每周重复进行超声评估，直至子宫内膜腔显示正常。
466例患者中，15例（3.2%）在第7天有RPOC症状，其余451例（96.8%）无症状，20例（57.9%）超声检查结果正常。15例有症状的患者（3.2%）进行了再次人工流产。这15例患者中，9例（60%）在第7天子宫内膜回声呈混合模式，2例（13.3%）呈高回声模式，其余4例（26.7%）子宫内膜回声正常。这15例患者中有12例（80%）的组织病理学检查显示有绒毛，其余3例未发现妊娠组织。第7天子宫内膜厚度≥10 mm对有症状女性RPOC诊断的敏感性为75%，特异性为100%。451例无症状患者均未出现任何症状或需要进一步干预。
由于无症状患者的超声检查异常结果会随时间恢复正常，RPOC的诊断不应基于超声检查结果。
