title: Clinical and imaging predictors of management in retained products of conception.
abstract: To determine if clinical and ultrasound (US) imaging features help predict management in clinically suspected retained products of conception (RPOC).
  
  
  
  334 patients sonographically evaluated for RPOC were included in this IRB-approved retrospective study. Of the 334 patients, 176 had sonographic diagnosis of RPOC and comprised the final study group. Patients were managed expectantly, medically, or surgically in accordance with clinical judgment of treating physicians. Pelvic sonograms were retrospectively reviewed for endometrial stripe thickness and vascularity was graded on a 0-3 scale based on appearance relative to myometrium (Grade 0: no vascularity, Grade 1: minimal vascularity, Grade 2: moderate vascularity, Grade 3: marked vascularity). Clinical and imaging predictors of management were evaluated in univariate and multivariate analysis.
  
  
  
  Mean patient age was 29.6 years and mean gestational age was 17.4 weeks. Most (74.4%) women presented with vaginal bleeding. 83 patients (47.2%) were treated conservatively with expectant management, 42 (23.8%) were treated medically, and 51 (29.0%) required surgical intervention. Mean endometrial stripe thickness was 21.3 mm. 47 women (26.7%) had vascularity score of 0; 50 (28.4%) had score 1; 52 (29.6%) had score 2; and 27 (15.3%) had score 3. In univariate analysis, serum hemoglobin (Hb) (p < 0.0001), endometrial stripe thickness on US (p < 0.005), presenting symptoms (p = 0.03), and US vascularity score (p < 0.005) were statistically significant predictors of final management. In multivariate logistic regression, serum Hb (OR 0.69, 95% CI 0.55-0.86, p < 0.0009), endometrial stripe thickness (OR 1.08, 95% CI 1.04-1.12, p < 0.0001), and US vascularity score (OR 1.77, 95% CI 1.16-2.70, p < 0.01) were statistically significant predictors of need for surgery.
  
  
  
  Serum Hb, endometrial stripe thickness, and US vascularity score were significant predictors of clinical management, particularly the need for surgical intervention, in women with clinically suspected RPOC.
authors.affiliation: Stanford University Medical Center, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA. kamaya@stanford.edu.
authors.forename: Aya
authors.identifier: 0000-0002-5159-9506
authors.initials: A
authors.lastname: Kamaya
authors.affiliation: Department of Radiology, Santa Clara Valley Medical Center, 751 S. Bascom Ave, San Jose, CA, 95128, USA.
authors.forename: Priya Menon
authors.initials: PM
authors.lastname: Krishnarao
authors.affiliation: Stanford University Medical Center, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA.
authors.forename: Nita
authors.initials: N
authors.lastname: Nayak
authors.affiliation: Stanford University Medical Center, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA.
authors.forename: R Brooke
authors.initials: RB
authors.lastname: Jeffrey
authors.affiliation: Department of Radiology, University of Michigan, 1500 E Med Ctr Dr, UH B1 D530H, Ann Arbor, MI, 48109, USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Maturen
mesh_terms: D000027:Abortion, Incomplete / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D000022:Abortion, Spontaneous / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D000328:Adult; D002824:Chorionic Villi / Q000000981:diagnostic imaging / Q000473:pathology; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D018457:Placenta, Retained / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*
keywords: Retained placenta; Retained products of conception; Retained trophoblastic tissue; Vascularity