Three-dimensional Doppler sonography in asymptomatic and symptomatic women after medical termination of pregnancy.
OBJECTIVE
To characterize the 3D Doppler sonographic appearance of the uterine cavity in asymptomatic and symptomatic women after administration of mifepristone and misoprostol for medical termination of pregnancy.


METHODS
A prospective observational study was performed. Women admitted for medical termination of pregnancy underwent transvaginal sonography 15 days after the procedure. Volumes were acquired, and offline analyses of the 3D vascularization indices were performed. Outcomes were collected at the follow-up scan and by telephone after the termination. Women were subclassified as asymptomatic or symptomatic according to the presence/absence of fever, vaginal bleeding, abdominal/pelvic pain, and infections. Spotting was defined as any episodic vaginal bleeding that was less than an expected menstruation and not regarded as a symptom.


RESULTS
A total of 104 women who underwent medical termination of pregnancy between 6 and 9 weeks' gestation were enrolled in the study. The termination procedure was successful in 98% of cases; among them, 9 women (8.6%) were symptomatic due to bleeding. Two asymptomatic women required surgery; 1 had sonographic evidence of suspected retained products of conception (endometrial thickness ≥ 15 mm or power Doppler vascularization presence). Fifty-seven women (55%) presented with retained products of conception. All the women with suspected retained products regained normal menses; of these, 3 symptomatic women with retained products (2.9%) underwent a 1-month sonographic follow-up. The symptomatic status was not associated with endometrial thickness, 3D intrauterine mass volume, or 2-dimensional (2D) and 3D power Doppler appearances.


CONCLUSIONS
The necessity of surgery after medical termination of pregnancy cannot be predicted by sonography. In cases with sonographic evidence of suspected retained products of conception, endometrial thickness, 2D Doppler findings, and the 3D vascularization indices correlated poorly with bleeding symptoms. Long-term follow-up should be considered in symptomatic women, and it can avoid any unnecessary surgical intervention.
Pregnancy Advisory Center, St George's University of London, Cranmer Terrace, London SW17 0RE, England. raffaelenapolitano@gmail.com.
Raffaele
R
Napolitano
Madhu
M
Ghosh
David J
DJ
Gillott
Kamal
K
Ojha
D000027:Abortion, Incomplete / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D000028:Abortion, Induced / Q000009:adverse effects / Q000706:statistics & numerical data*; D000328:Adult; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data*; D008131:London / Q000453:epidemiology; D008137:Longitudinal Studies; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000706:statistics & numerical data*; D014599:Uterus / Q000000981:diagnostic imaging*
3-dimensional power Doppler flow; Virtual Organ Computer-Aided Analysis; gynecologic ultrasound; medical termination of pregnancy; sonography