Clinical and Sonographic Findings in Suspected Retained Trophoblast after Pregnancy Do Not Predict the Disorder

Abstract 

Study 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.

Design

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

Setting

A tertiary referral hospital.

Patients

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

Interventions

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.

Measurements and Main 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.

Keywords: Residual trophoblast, Retained pregnancy material, Hysteroscopy