Omakwu Oine, Uppal Talat, Infante Torres Fernando
Department of Obstetrics and Gynaecology Northern Beaches Health Service Mona Vale New South Wales Australia.
Australas J Ultrasound Med. 2016 May 20;19(2):78-83. doi: 10.1002/ajum.12012. eCollection 2016 May.
Post-partum haemorrhage is a serious complication of vaginal and Caesarean deliveries, and a major cause of maternal morbidity and mortality. Retained products of conception (RPOC) are implicated in both primary and secondary post-partum haemorrhage, frequently leading to surgical interventions. Ultrasonographic diagnosis of RPOC gives a wide variation in accuracy due to significant overlaps between the normal and pathological features of the post-partum uterus. The inaccuracy of current diagnostic tools coupled with high rates of complications associated with surgical treatment poses a complex challenge to the physician.
A 37-year old para 3 woman who had a vaginal delivery at term following an uncomplicated pregnancy. She had active management of the third stage of labour, and the placenta was delivered with missing fragments and ragged membranes. She had both primary and secondary post-partum haemorrhage with a total blood loss of 1140 mL. An ultrasonographic scan of the uterus on day 3 post-partum was suggestive of RPOC. Interventions included uterotonics, antibiotics, iron infusion, blood transfusion, and dilatation and curettage of RPOC, confirmed on histopathological analysis. She remained clinically stable post-operatively and was discharged 2 days later.
Evidence currently promotes a combination of ultrasonography and clinical assessment in the diagnosis of RPOC. Each of these methods of assessments has significant shortcomings in terms of accuracy. When combined, determination of the most appropriate treatment and avoidance of unnecessary surgical interventions and associated complications become more feasible.
产后出血是阴道分娩和剖宫产的严重并发症，是孕产妇发病和死亡的主要原因。妊娠物残留（RPOC）与原发性和继发性产后出血均有关，常导致手术干预。由于产后子宫的正常特征和病理特征存在显著重叠，超声诊断RPOC的准确性差异很大。当前诊断工具的不准确以及与手术治疗相关的高并发症发生率给医生带来了复杂的挑战。
一名37岁经产妇，妊娠期间无并发症，足月顺产。她接受了积极的第三产程管理，胎盘娩出时伴有碎片缺失和胎膜不完整。她发生了原发性和继发性产后出血，总失血量为1140毫升。产后第3天子宫超声扫描提示妊娠物残留。干预措施包括使用宫缩剂、抗生素、输注铁剂、输血以及对妊娠物残留进行刮宫术，组织病理学分析证实了这一诊断。术后她临床情况稳定，2天后出院。
目前有证据支持在诊断妊娠物残留时将超声检查与临床评估相结合。这些评估方法在准确性方面都有显著不足。两者结合使用时，确定最合适的治疗方法以及避免不必要的手术干预和相关并发症变得更可行。
