BACKGROUND: 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. CASE: 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. CONCLUSION: 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.
BACKGROUND: 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. CASE: 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. CONCLUSION: 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.
Authors: Amanda Henry; Mary-Rose Birch; Elizabeth A Sullivan; Sue Katz; Yueping Alex Wang Journal: Aust N Z J Obstet Gynaecol Date: 2005-06 Impact factor: 2.100
Authors: S B Cohen; A Kalter-Ferber; B S Weisz; Y Zalel; D S Seidman; S Mashiach; A L Lidor; M Zolti; M Goldenberg Journal: J Am Assoc Gynecol Laparosc Date: 2001-05