Transvaginal ultrasound and sonohysterography for assessment of postpartum residual trophoblastic tissue.
OBJECTIVE
To compare the accuracy of transvaginal ultrasound and sonohysterography (SHG) in diagnosing residual trophoblastic tissue in postpartum women and to assess the adverse effects and complications of the SHG procedure.


METHODS
A prospective study of patients with postpartum bleeding enrolled for clinical symptoms and signs of residual trophoblastic tissue. All women underwent transvaginal ultrasound and SHG. Uterine cavity curettage was performed in all women and the material collected was sent for pathologic examination.


RESULTS
Among 84 patients, transvaginal ultrasound revealed residual trophoblastic tissue in 60 women, whereas SHG detected residual trophoblastic tissue in 48 and blood clots in 12. Pathologic examination confirmed trophoblastic tissue in 48 patients and blood clots in 12. Fifteen (17.9%) patients experienced adverse effects after SHG. Thirteen (15.5%) experienced postprocedural fever that resolved with antibiotics. Two women (2.4%) had severe complications of infection: 1 required surgery for peritonitis, which revealed salpingitis and a pelvic abscess; 1 experienced fever and mild abdominal pain that resolved with antibiotics after 10 days of hospitalization.


CONCLUSIONS
Although SHG showed greater accuracy than transvaginal ultrasound in detecting residual trophoblastic tissue, a high proportion of patients experienced adverse effects.
Cosmi
Erich
E
Department of Gynecological Science and Human Reproduction, University of Padua School of Medicine, Padua, Italy. ecosmi@hotmail.com
Saccardi
Carlo
C
Litta
Pietro
P
Nardelli
Giovanni B
GB
Dessole
Salvatore
S
D000328:Adult; D005260:Female; D006801:Humans; D018457:Placenta, Retained / Q000000981:diagnostic imaging*; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D011247:Pregnancy; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods; D014599:Uterus / Q000000981:diagnostic imaging