A Dilation and Curettage (D&C) is a medical procedure that widens the cervix and removes tissue from the uterus. It is performed after a miscarriage or abortion, or for uterine conditions like abnormal bleeding. Retained tissue refers to any placental or fetal tissue remaining inside the uterus after a D&C.
How Often Retained Tissue Occurs
Retained tissue after a D&C is a known possibility, with its frequency varying. Studies indicate the incidence of retained products of conception (RPOC) following a miscarriage or abortion can range from 1% to 20%. Some research suggests it may be more common after a first-trimester miscarriage.
The reason for the D&C also influences the likelihood of retained tissue. Incidence may differ between procedures for incomplete miscarriage versus elective abortion. Factors contributing to its occurrence include the initial completeness of tissue removal, pregnancy size, and individual uterine characteristics. The medical professional’s expertise also plays a role.
Recognizing Signs
If retained tissue is present after a D&C, signs and symptoms emerge days or weeks later. A common indicator is persistent or heavy vaginal bleeding that is more profuse or lasts longer than expected. This bleeding may be accompanied by severe abdominal pain or cramping, more intense or prolonged than usual post-procedure discomfort.
Other signs include fever, a foul-smelling vaginal discharge, and a general feeling of being unwell, including fatigue or chills. These symptoms can indicate an infection. Any of these symptoms warrant immediate medical attention, as they signal retained tissue requiring further evaluation and management.
Confirmation and Care
When retained tissue is suspected after a D&C, healthcare providers employ diagnostic methods. Transvaginal ultrasound is the primary imaging technique, providing detailed views of the uterine cavity to identify any remaining tissue. It can reveal echogenic masses, suggesting retained products of conception. Doppler ultrasound may assess blood flow to differentiate tissue from other uterine contents.
Blood tests also measure human chorionic gonadotropin (hCG) levels. While hCG levels naturally decline after a D&C, persistently elevated or slowly declining levels can suggest residual placental tissue. Once confirmed, care depends on the amount of tissue, symptom severity, and the patient’s overall health.
For small amounts of tissue without infection, “watchful waiting” may be considered, allowing the body to naturally expel it. Medical management often involves medications, such as misoprostol, to aid in the expulsion of retained tissue. If the tissue is substantial, symptoms are severe, or medical management is unsuccessful, a repeat D&C may be necessary to remove the remaining tissue.
Why Addressing Retained Tissue Matters
Prompt diagnosis and treatment of retained tissue prevent potential complications. Untreated, it can lead to serious health issues. Infection, known as endometritis, is a primary concern, causing fever, pain, and potential spread. Hemorrhage, or excessive and prolonged bleeding, is another significant risk, leading to anemia or requiring blood transfusions.
Untreated retained tissue can also contribute to Asherman’s syndrome, a condition characterized by scar tissue inside the uterus. This scarring can affect the uterine lining, potentially leading to menstrual irregularities or difficulties with future pregnancies. Promptly addressing retained tissue minimizes these risks and supports the patient’s recovery and long-term reproductive health.