Obstetrics and Gynecology, Assaf Harofeh Medical Center, Tel Aviv University, Zerifin, Israel.
Ultraschall Med. 2018 Dec;39(6):643-649. doi: 10.1055/s-0043-113817. Epub 2017 Sep 21.
To investigate whether ultrasound follow-up for the detection of postpartum retained products of conception (RPOC) in women considered at risk for this condition may allow for early diagnosis.
Parturients at risk for RPOC underwent an ultrasound exam on the second postpartum day. Based on the ultrasound findings, women were either: (1) discharged to routine postpartum care in cases of normal scans, (2) invited for follow-up in cases of abnormal scans. We retrospectively analyzed the rates of women requiring uterine evacuation due to persistent abnormal scans.
761 parturients (out of 17 010 deliveries, 4.5 %) were included. Of those, 490 (64.4 %) women had a normal initial scan, but two of them were later readmitted for uterine evacuation. The remaining 271 (35.6 %) women were found to have an abnormal scan: (a) thickened endometrium > 10 mm with hypo- and hyper-echoes and negative Doppler flow considered low suspicion for RPOC was described in 260 cases, of whom 23 (8.8 %) underwent uterine evacuation with placental remnants confirmed in 12/23 (52.2 %), and (b) an echogenic mass with positive Doppler flow considered high suspicion for RPOC was described in 11 cases, all of whom underwent uterine evacuation, with placental remnants confirmed in 9/11 (81.8 %). The number of scans required to detect RPOC in one patient was 33.
Postpartum ultrasound evaluation may allow for early diagnosis of RPOC in women considered at risk for this condition.
探讨对有产后胎盘残留（RPOC）风险的女性进行超声随访以早期诊断该病的效果。
有 RPOC 风险的产妇在产后第 2 天行超声检查。根据超声结果，将患者分为以下两类：（1）若检查正常，则常规进行产后护理；（2）若检查异常，则进行随访。我们对因持续性异常扫描而需要行清宫术的女性比例进行了回顾性分析。
共纳入 17010 例分娩中的 761 例产妇（4.5%）。其中，490 例（64.4%）产妇初始扫描正常，但其中 2 例后来因需行清宫术而再次入院。其余 271 例（35.6%）产妇的扫描结果异常：（a）子宫内膜增厚＞10mm，伴有低回声和高回声，且无血流，提示低疑似 RPOC，260 例患者中描述为这种情况，其中 23 例（8.8%）行清宫术，12/23 例（52.2%）证实有胎盘残留；（b）超声回声团伴血流阳性，提示高疑似 RPOC，11 例患者均行清宫术，9/11 例（81.8%）证实有胎盘残留。每位患者需行 33 次超声检查才能确诊 RPOC。
对有 RPOC 风险的女性进行产后超声评估可能有助于早期诊断该病。
