Wada Yoshimitsu, Takahashi Hironori, Suzuki Hirotada, Ohashi Mai, Ogoyama Manabu, Nagayama Shiho, Baba Yosuke, Usui Rie, Suzuki Tatsuya, Ohkuchi Akihide, Fujiwara Hiroyuki
Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan.
Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan.
Eur J Obstet Gynecol Reprod Biol. 2021 May;260:1-5. doi: 10.1016/j.ejogrb.2021.02.028. Epub 2021 Mar 2.
To clarify the natural history of retained products of conception (RPOC) following abortion at less than 22 weeks of gestation, and those who show major bleeding during course observation.
We retrospectively reviewed 640 patients who had spontaneous or artificial abortion at less than 22 weeks of gestation between January 2011 and August 2019 in our institute. Of those, patients with RPOC were included. The maternal background, RPOC characteristics, and subsequent complications including additional interventions were reviewed.
Fifty-four patients with RPOC were included. The incidence of RPOC was 6.7 %. The median (interquartile range: IQR) RPOC length was 29 (20-38) mm. RPOC hypervascularity was observed in 26 (48 %) patients. The median (IQR) periods of RPOC flow disappearance and RPOC disappearance on ultrasound from abortive treatment were 50 (28-76) and 84 (50-111) days, respectively. Of the 54, 44 patients were selected for expectant management. Of the 44, 34 (77 %) patients were observed without intervention (recovery group); the other 10 (23 %) patients required additional interventions associated with subsequent bleeding (intervention group). Compared with the recovery group, heavy bleeding (> 500 mL) at abortion (6/10: 60 %) and RPOC hypervascularity (8/10: 80 %) were more frequently observed in the intervention group.
Expectant management was successful in almost 80 % of patients with RPOC following abortion. The additional interventions were required in patients with heavy bleeding at abortion and RPOC hypervascularity.
明确妊娠22周前流产后妊娠物残留（RPOC）的自然病程，以及在病程观察期间出现大出血的患者情况。
我们回顾性分析了2011年1月至2019年8月在我院妊娠22周前进行自然流产或人工流产的640例患者。其中纳入了有RPOC的患者。对产妇背景、RPOC特征以及包括额外干预措施在内的后续并发症进行了回顾。
纳入了54例有RPOC的患者。RPOC的发生率为6.7%。RPOC的中位（四分位间距：IQR）长度为29（20 - 38）mm。26例（48%）患者观察到RPOC血管增多。流产治疗后超声检查中RPOC血流消失和RPOC消失的中位（IQR）时间分别为50（28 - 76）天和84（50 - 111）天。54例患者中，44例选择了期待治疗。44例中，34例（77%）患者未接受干预观察（恢复组）；另外10例（23%）患者因后续出血需要额外干预（干预组）。与恢复组相比，干预组在流产时大出血（>500 mL）（6/10：60%）和RPOC血管增多（8/10：80%）的情况更常见。
妊娠22周前流产后RPOC患者中，近80%的期待治疗成功。流产时大出血和RPOC血管增多的患者需要额外干预。
