Clinical and sonographic findings in suspected retained trophoblast after pregnancy do not predict the disorder.
OBJECTIVE
Our aim was to estimate whether there are clinical, sonographic, or intraoperative parameters that have good correlation with the final histologic study after hysteroscopic removal of suspected retained trophoblast of conception.


METHODS
Retrospective case control study (Canadian Classification II-2).


METHODS
A tertiary referral hospital.


METHODS
Sixty-four patients after hysteroscopic removal of suspected retained pregnancy material.


METHODS
We divided our patients into those with true trophoblast on histologic evaluation (group A, n=40) and patients with other histologic findings (group B, n=24). Clinical parameters, as well as sonographic evidence leading to hysteroscopy were correlated with final pathology report.


RESULTS
Age, obstetric history, type of obstetric event, and time between primary event and hysteroscopy were not statistically different between the true trophoblast and nontrophoblast groups. Clinical signs and symptoms (fever, bleeding, and abdominal pain), as well as sonographic findings (size of retained mass and Doppler flow) were not statistically different between the 2 groups and thus could not predict the final disease. The only parameter correlated significantly to final histologic findings was the intraoperative surgeon's opinion of the retained material.


CONCLUSIONS
Various clinical parameters, as well as sonographic findings including the size of the mass and Doppler test results in patients with suspected retained trophoblast, do not predict the final diagnosis. The surgeon's opinion regarding the tissue seen during hysteroscopy is the only parameter tested that correlates well with the final histologic evaluation. Thus selective removal of retained trophoblast can be performed on the basis of the surgeon's opinion during the procedure, whereas further potentially harmful interventions (curettage) can be avoided when true trophoblast is not suspected to minimize complications.
Department of Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. ishai.levin@gmail.com
Ishai
I
Levin
Benny
B
Almog
Baris
B
Ata
Gilad
G
Ratan
Ariel
A
Many
D000028:Abortion, Induced; D000328:Adult; D016022:Case-Control Studies; D003475:Curettage; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D018457:Placenta, Retained / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011247:Pregnancy; D012189:Retrospective Studies; D014463:Ultrasonography