Al Amri Iman, Al Aufi Zahra, Al Bash Majeda, Jose Sachin, Al Riyami Nihal
Obstetrics and Gynecology Residency Training Program, Oman Medical Specialty Board, Muscat, Oman.
Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
Oman Med J. 2023 Mar 31;38(2):e484. doi: 10.5001/omj.2023.63. eCollection 2023 Mar.
This study aimed to assess the proportion of women who underwent postpartum evacuation and were histopathologically confirmed to have retained products of conception (RPOC), compare the reliability of histopathology and ultrasound (US) in determining the presence of RPOC, and assess the maternal complications associated with postpartum evacuation.
A retrospective cross-sectional study was conducted on all women who delivered and had postpartum evacuation at a tertiary teaching hospital in Oman over 11 years from May 2009 to May 2020. The participants were divided into two groups based on their histopathology results. McNemar test was used to compare the sonographic results with the histopathological findings.
A total of 151 women were included in this study. The diagnosis of RPOC was confirmed in histopathological reports of 64 (42.4%) women (group 1) but not in 87 (57.6%) women (group 2). There was no significant difference between the two groups in maternal characteristics. Parameters of clinical presentation including fever and abdominal pain were significantly different between the two groups (0.026 and 0.028, respectively). Vaginal bleeding was not significantly different between the groups (0.255. Pelvic US detected RPOC in 135 (89.4%) women whereas the histopathology confirmed it in 64 (42.4%) women ( < 0.001). The sensitivity of US compared to histopathology in diagnosing RPOC was 98.4% (95% CI: 91.60-99.96) and the specificity was 17.2% (95% CI: 9.98-26.84). The overall diagnostic accuracy of US in detecting RPOC was 51.7%. Two (1.3%) women had hysterectomy as a result of the evacuation. Histopathology showed smooth muscle in 20 (13.2%) women. Significant bleeding during surgery occurred in 17 (11.3%) cases.
Diagnosis of postpartum RPOC is challenging. Our results highlighted the complexity of diagnosing RPOC. Special training is needed for doctors to diagnose RPOC from transvaginal scans. A multicenter study in Oman with a larger sample size is recommended to confirm our findings.
本研究旨在评估接受产后清宫术且经组织病理学确诊有妊娠物残留（RPOC）的女性比例，比较组织病理学和超声（US）在确定RPOC存在方面的可靠性，并评估与产后清宫术相关的母体并发症。
对2009年5月至2020年5月在阿曼一家三级教学医院分娩并接受产后清宫术的所有女性进行了一项回顾性横断面研究。根据组织病理学结果将参与者分为两组。采用McNemar检验将超声检查结果与组织病理学结果进行比较。
本研究共纳入151名女性。64名（42.4%）女性的组织病理学报告确诊为RPOC（第1组），87名（57.6%）女性未确诊（第2组）。两组产妇特征无显著差异。两组临床表现参数包括发热和腹痛有显著差异（分别为0.026和0.028）。两组间阴道出血无显著差异（0.255）。盆腔超声在135名（89.4%）女性中检测到RPOC，而组织病理学确诊64名（42.4%）女性有RPOC（<0.001）。与组织病理学相比，超声诊断RPOC的敏感性为98.4%（95%CI：91.60 - 99.96），特异性为17.2%（95%CI：9.98 - 26.84）。超声检测RPOC的总体诊断准确性为51.7%。两名（1.3%）女性因清宫术行子宫切除术。组织病理学显示20名（13.2%）女性有平滑肌。17例（11.3%）手术中发生大出血。
产后RPOC的诊断具有挑战性。我们的结果突出了诊断RPOC的复杂性。医生需要接受特殊培训以通过经阴道扫描诊断RPOC。建议在阿曼进行一项样本量更大的多中心研究以证实我们的发现。
