Retained products of conception (RPOC) refer to any pregnancy-related tissue that remains in the uterus after a pregnancy ends, whether through childbirth, miscarriage, or abortion. Understanding RPOC is important due to potential complications if not addressed.
Understanding Retained Products
Retained products of conception (RPOC) are tissues from a pregnancy, such as placental tissue, fetal membranes, or a pregnancy sac, that are not completely expelled from the uterus. This can occur after a miscarriage, abortion, or delivery. While the exact cause is not always clear, factors like placenta accreta, advanced maternal age, assisted delivery, or previous uterine surgeries can increase the risk.
Recognizing and Diagnosing Retained Products
Signs and symptoms of retained products of conception include persistent or heavy vaginal bleeding, often heavier than a normal period or containing large blood clots. Other indicators can be pelvic pain, fever, an enlarged and tender uterus, or a missed menstrual period after the pregnancy event. Diagnosis typically involves a physical examination. Ultrasound, particularly transvaginal ultrasound, is a primary tool to identify RPOC by looking for a thickened uterine lining or tissue masses. Color Doppler ultrasound can further enhance diagnosis by showing blood flow to remaining tissue, helping differentiate it from blood clots. Blood tests measuring human chorionic gonadotropin (hCG) levels may also be used, as elevated or persistently positive hCG levels can indicate the presence of placental tissue.
Conceiving While Retained Products Are Present
Conceiving a new pregnancy with retained products of conception (RPOC) present is generally unlikely. The presence of RPOC disrupts the body’s normal physiological processes necessary for a new pregnancy to establish itself. Continued production of hCG by the retained tissue can interfere with the resumption of the regular menstrual cycle and ovulation, preventing the body from preparing for a new pregnancy. Furthermore, RPOC creates an unsuitable environment within the uterus for a new embryo to implant and thrive. The retained tissue can act as a physical barrier, preventing proper implantation of a fertilized egg. The uterine lining may also not develop correctly. Even if implantation were to occur, the compromised uterine environment could lead to an increased risk of early pregnancy loss.
Potential Health Consequences
If retained products of conception are left untreated, various medical complications can arise. A significant risk is infection, which can lead to endometritis, an inflammation of the uterine lining. Symptoms of infection may include fever, foul-smelling vaginal discharge, and increased pelvic pain. Untreated infections can progress to more severe conditions like sepsis, a life-threatening response to infection. Another common complication is heavy or prolonged bleeding, potentially leading to anemia due to excessive blood loss. Long-term consequences can include intrauterine adhesions, also known as Asherman’s syndrome. This condition involves scar tissue forming inside the uterus, which can impact future fertility by making it difficult for an embryo to implant or by leading to recurrent miscarriages.
Treatment and Planning Future Pregnancies
Managing retained products of conception involves several approaches, depending on the amount of tissue and the individual’s condition. Expectant management, where the body naturally expels the tissue, may be an option for small amounts of RPOC, especially without infection or excessive bleeding. Medical management often involves medications like misoprostol, administered orally or vaginally, which helps the uterus contract and expel remaining tissue.
Surgical removal is another common treatment for larger amounts of retained tissue, heavy bleeding, or infection. Procedures include Dilation and Curettage (D&C), which involves dilating the cervix and gently removing tissue, and Hysteroscopy, using a thin, lighted tube with a camera for direct visualization and removal, potentially reducing uterine scarring.
After successful treatment, most individuals can become pregnant again and have healthy pregnancies. Healthcare providers generally recommend waiting until at least one menstrual period has occurred after treatment to allow the uterus to heal before attempting conception again.