Levinsohn-Tavor Orna, Sharon Nataly Zilberman, Feldman Noa, Svirsky Ran, Smorgick Noam, Nir-Yoffe Arava, Maymon Ron
Department of Obstetrics and Gynecology, The Yitzhak 37256Shamir Medical Center (formerly 37256Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Acta Radiol. 2022 Mar;63(3):410-415. doi: 10.1177/0284185121991464. Epub 2021 Jan 31.
Suspicion of retained products of conception (RPOC) often arises after delivery and still poses a diagnostic and management challenge.
To prospectively evaluate a sonographic classification for the management of patients with suspected RPOC after delivery.
Based on grayscale and Doppler ultrasound parameters, patients were classified into high, moderate, or low probability of RPOC. For the low and moderate probability groups, an ultrasound follow-up at the end of the puerperium was recommended. For the high probability group, a follow-up examination was conducted 10-14 days after the first ultrasound, and patients with persistent high probability findings were referred for surgical intervention.
The sample was composed of 215 patients at risk of RPOC. Of these, 100, 93, and 22 patients were classified as having a low, moderate, or high probability of RPOC, respectively. Rates of RPOC were 55%, 2%, and 2% in the high, moderate, and low probability categories, respectively. When the categorization was based on the most recent ultrasound obtained during the puerperium, the adjusted RPOC prevalence rates were 71% in the high, 6% in the moderate, and 0% in the low probability groups.
This study confirms the effectiveness of our sonographic classification for managing patients with suspected RPOC after delivery. In all three categories, it is recommended to adhere to a conservative management protocol in clinically stable women until the end of the puerperium. This approach provides good predictability for RPOC and can reduce unnecessary surgical interventions.
产后常常会怀疑有妊娠物残留（RPOC），这仍然是一个诊断和管理方面的挑战。
前瞻性评估一种超声分类方法，用于产后疑似RPOC患者的管理。
根据灰阶和多普勒超声参数，将患者分为RPOC高、中、低概率组。对于低概率和中概率组，建议在产褥期末进行超声随访。对于高概率组，在首次超声检查后10 - 14天进行随访检查，持续出现高概率结果的患者转诊接受手术干预。
样本包括215例有RPOC风险的患者。其中，分别有100、93和22例患者被分类为RPOC低、中、高概率组。高、中、低概率组的RPOC发生率分别为55%、2%和2%。当根据产褥期获得的最新超声进行分类时，高概率组调整后的RPOC患病率为71%，中概率组为6%，低概率组为0%。
本研究证实了我们的超声分类方法对产后疑似RPOC患者管理的有效性。在所有三个类别中，建议对临床稳定的女性坚持保守管理方案直至产褥期末。这种方法对RPOC具有良好的预测性，并可减少不必要的手术干预。
