Retained Products of Conception

History: 35 year old female with vaginal bleeding after 1st trimester miscarriage. 

Retained products of conception: sagittal transvaginal ultrasound of the uterus demonstrates a heterogeneous and thickened endometrium (yellow arrows).

Retained products of conception: sagittal transvaginal ultrasound of the uterus with color Doppler demonstrates feeding vessels extending into the retained placental tissues (yellow arrows).

This is a case of retained products of conception. Retained products of conception can occur after miscarriage, abortion, normal delivery, or after a dilatation and curretage procedure. Clinical examination and symptoms of retained products of conception are nonspecific and may mimic those that occur during the normal postpartum stage. In some cases, RPOC is suspected when there is prolonged or sustained vaginal bleeding after delivery.

The differential diagnosis of the above imaging appearance includes:

1. Blood clot (would not show flow on color Doppler images)

2. Endometritis (clinically presents with fever and focal uterine tenderness)

3. Normal postpartum endometrium (should decrease in thickness progressively with time)

4. Molar pregnancy (would have elevated hCG levels)

5. Missed abortion (could show more fetal tissue still present in gestation sac)

References:

Physiologic, Histologic, and Imaging Features of Retained Products of Conception. RadioGraphics 2013; 33:781–796.