Incognito Giosuè Giordano, Ettore Carla, De Tommasi Orazio, Tozzi Roberto, Ettore Giuseppe
Obstetrics and Gynecology Unit, Maternal Child Department, ARNAS Garibaldi Nesima, 95122 Catania, Italy.
Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, 35122 Padua, Italy.
J Clin Med. 2025 Aug 19;14(16):5864. doi: 10.3390/jcm14165864.
Retained products of conception (RPOC) represent a significant cause of morbidity in the post-abortive and postpartum periods, potentially leading to abnormal uterine bleeding, pelvic pain, infections, and intrauterine adhesions. Accurate diagnosis is crucial to avoid unnecessary surgical interventions and to preserve future fertility. Transvaginal ultrasound constitutes the primary imaging modality for identifying RPOC, but the lack of standardized diagnostic criteria complicates clinical decision-making. This narrative review explores the current literature on sonographic findings associated with RPOC, focusing on the diagnostic value of endometrial thickness (ET), the presence of intrauterine echogenic masses, and the use of Color Doppler imaging. Although an ET ≥15 mm is frequently used to suspect RPOC, the variability in cut-off thresholds and limited specificity reduce its diagnostic reliability. The detection of an echogenic intrauterine mass appears to be the most sensitive and specific sonographic feature. Color Doppler assessment, particularly the presence of enhanced myometrial vascularity (EMV) and classification systems like the Gutenberg score, offers further insight by stratifying hemorrhagic risk and guiding therapeutic choices. However, vascular parameters such as peak systolic velocity (PSV) and resistive index (RI) demonstrate a substantial overlap between benign and pathological conditions, limiting their stand-alone utility. The review also addresses the differential diagnosis of RPOC, including blood clots, arteriovenous malformations, placental polyps, gestational trophoblastic disease, and endometrial osseous metaplasia. The role of three-dimensional ultrasound remains limited in clinical practice, offering no significant advantage over two-dimensional imaging. Finally, the timing of follow-up ultrasound after medical treatment with misoprostol is critical: delayed assessment reduces overtreatment by allowing time for spontaneous resolution. In conclusion, despite advances in ultrasound technology, the diagnosis of RPOC remains challenging due to heterogeneity in imaging findings and inter-observer variability. A multimodal approach integrating grayscale and Doppler ultrasound with clinical evaluation is essential for optimal management.
稽留流产组织（RPOC）是流产后和产后发病的一个重要原因，可能导致异常子宫出血、盆腔疼痛、感染和宫腔粘连。准确诊断对于避免不必要的手术干预和保护未来生育能力至关重要。经阴道超声是识别RPOC的主要影像学检查方法，但缺乏标准化的诊断标准使临床决策变得复杂。这篇叙述性综述探讨了目前关于与RPOC相关的超声检查结果的文献，重点关注子宫内膜厚度（ET）的诊断价值、宫腔内强回声团块的存在以及彩色多普勒成像的应用。虽然ET≥15mm常被用于怀疑RPOC，但截断阈值的变异性和有限的特异性降低了其诊断可靠性。宫腔内强回声团块的检测似乎是最敏感和特异的超声特征。彩色多普勒评估，特别是子宫肌层血管增多（EMV）的存在以及像古腾堡评分这样的分类系统，通过对出血风险进行分层和指导治疗选择提供了进一步的见解。然而，诸如收缩期峰值速度（PSV）和阻力指数（RI）等血管参数在良性和病理情况之间存在大量重叠，限制了它们的单独应用。该综述还讨论了RPOC的鉴别诊断，包括血凝块、动静脉畸形、胎盘息肉、妊娠滋养细胞疾病和子宫内膜骨化生。三维超声在临床实践中的作用仍然有限，与二维成像相比没有显著优势。最后，米索前列醇药物治疗后随访超声检查的时机至关重要：延迟评估通过留出时间让其自发消退减少了过度治疗。总之，尽管超声技术有所进步，但由于影像学表现的异质性和观察者间的差异，RPOC的诊断仍然具有挑战性。将灰阶和多普勒超声与临床评估相结合的多模式方法对于优化管理至关重要。
