Selvan Pather1, Monica Ford, Rosemary Reid, Peter Sykes. 1. University Department of Obstetrics and Gynaecology, Christchurch School of Medicine and Christchurch Women's Hospital, Christchurch, New Zealand. selvan.pather@email.cs.nsw.gov.au
Abstract
AIM: To assess whether delivery details, clinical features at presentation and laboratory investigations could accurately predict the presence of retained products of conception (RPOC) following a postpartum curettage (PPC) and to assess the morbidity associated with this procedure. METHODS: A retrospective chart review of patients who underwent a PPC at a tertiary referral hospital over a 5-year period. RESULTS: Two hundred patients were included in the study and 50% of patients who had histological evaluation demonstrated retained product of conception. Mode of delivery, placental status at delivery and immediate postpartum haemorrhage was unrelated to final histology however, patients presenting with pelvic infection were significantly less likely to have RPOC, chi(2 )= 6.358 (P = 0.042). The sensitivity and specificity of ultrasound in detecting RPOC was 94% and 16%, respectively; the presence of an echogenic focus together with a thickened endometrium of more than 10 mm was the most accurate ultrasound feature of RPOC (positive predictive value 80%). Seventeen (8.5%) patients experienced major morbidity following curettage and 14 (7%) underwent a repeat procedure with further morbidity. Patients presenting with pelvic infection were more likely to experience postoperative morbidity. CONCLUSION: A PPC has a low diagnostic yield and is associated with a significant complication rate. While the therapeutic benefit of this procedure is unclear, expectant management is appropriate especially in the presence of pelvic sepsis.
AIM: To assess whether delivery details, clinical features at presentation and laboratory investigations could accurately predict the presence of retained products of conception (RPOC) following a postpartum curettage (PPC) and to assess the morbidity associated with this procedure. METHODS: A retrospective chart review of patients who underwent a PPC at a tertiary referral hospital over a 5-year period. RESULTS: Two hundred patients were included in the study and 50% of patients who had histological evaluation demonstrated retained product of conception. Mode of delivery, placental status at delivery and immediate postpartum haemorrhage was unrelated to final histology however, patients presenting with pelvic infection were significantly less likely to have RPOC, chi(2 )= 6.358 (P = 0.042). The sensitivity and specificity of ultrasound in detecting RPOC was 94% and 16%, respectively; the presence of an echogenic focus together with a thickened endometrium of more than 10 mm was the most accurate ultrasound feature of RPOC (positive predictive value 80%). Seventeen (8.5%) patients experienced major morbidity following curettage and 14 (7%) underwent a repeat procedure with further morbidity. Patients presenting with pelvic infection were more likely to experience postoperative morbidity. CONCLUSION: A PPC has a low diagnostic yield and is associated with a significant complication rate. While the therapeutic benefit of this procedure is unclear, expectant management is appropriate especially in the presence of pelvic sepsis.