title: Is ultrasonographic evaluation essential for diagnosis of retained products of conception after surgical abortion?
abstract: OBJECTIVE
  The aim of this study was to evaluate the predictive value of symptomatic evaluation with transvaginal ultrasonographic findings for diagnosis of retained products of conception (RPOC) after voluntary pregnancy termination via manual vacuum aspiration (MVA).
  
  
  METHODS
  A total of 466 patients with a gestational age < 10 weeks were followed up at the 7th day after MVA of unwanted pregnancies. The patients who had intense or moderate bleeding and other symptoms related to RPOC had a re-evacuation and all the patients were followed up until the next menstruation. Ultrasonographic evaluation was repeated weekly in asymptomatic patients with abnormal ultrasonographic findings (increased endometrial thickness, presence of hyperechogenic, mixed and hypoechogenic material) until a normal endometrial cavity was visualized.
  
  
  RESULTS
  Out of the 466 patients, 15 (3.2%) had symptoms of RPOC at day 7 while the remaining 451 (96.8%) were asymptomatic and 20 (57.9%) had normal ultrasonographic findings. The 15 symptomatic patients (3.2%) had a repeated MVA. Nine of these 15 patients (60%) had endometrial echogenicity with mixed patterns, two (13.3%) had endometrial echogenicity with hyperechoic patterns, and the remaining four (26.7%) had normal endometrial echogenicity at day 7. Histopathologic examination of 12 of these 15 patients (80%) showed chorionic villi while no gestational tissue was noted in the remaining three of these patients. Endometrial thickness ≥ 10 mm on day 7 had 75% sensitivity and 100% specificity for diagnosis of RPOC in symptomatic women. None of the 451 asymptomatic patients developed any symptoms or needed any further intervention.
  
  
  CONCLUSIONS
  As abnormal ultrasonographic findings return to normal over time in asymptomatic patients, the diagnosis of RPOC should not be based on ultrasonographic findings.
authors.affiliation: Başkent University, Department of Obstetric and Gynecology, Konya, Turkey.
authors.forename: Yusuf Aytaç
authors.initials: YA
authors.lastname: Tohma
authors.affiliation: Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Berna
authors.initials: B
authors.lastname: Dilbaz
authors.affiliation: Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Evliyaoğlu
authors.affiliation: Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Bora
authors.initials: B
authors.lastname: Çoşkun
authors.affiliation: Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Eser
authors.initials: E
authors.lastname: Çolak
authors.affiliation: Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Dilbaz
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D004717:Endometrium / Q000473:pathology; D005260:Female; D005865:Gestational Age; D006801:Humans; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging* / Q000473:pathology; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: manual vacuum aspiration; retained products of conception; ultrasonography