Retained products of conception refers to when pregnancy-related tissue (e.g. placental tissue or fetal membranes) remain in the uterus after delivery. It can also occur after miscarriage or termination of pregnancy.
Placenta accreta is a significant risk factor for retained products of conception.
Presentation
Retained products of conception may be present in patients without any suggestive symptoms. It may present with:
- Vaginal bleeding that gets heavier or does not improve with time
- Abnormal vaginal discharge
- Lower abdominal or pelvic pain
- Fever (if infection occurs)
Diagnosis
Ultrasound is the investigation of choice for confirming the diagnosis.
Management
The standard management of postpartum retained products of conception is to remove them surgically.
Evacuation of retained products of conception (ERPC) is a surgical procedure involving a general anaesthetic. The cervix is gradually widened using dilators, and the retained products are manually removed through the cervix using vacuum aspiration and curettage (scraping). The procedure may be referred to as “dilatation and curettage”. Two key complications are:
- Endometritis
- Asherman’s syndrome
Asherman’s syndrome is where adhesions (sometimes called synechiae) form within the uterus. Endometrial curettage (scraping) can damage the basal layer of the endometrium. This damaged tissue may heal abnormally, creating scar tissue (adhesions) connecting areas of the uterus that are generally not connected. There may be adhesions binding the uterine walls together, or within the endocervix, sealing it shut. This can lead to infertility.
Last updated September 2020