Retained products of conception (RPOC) is a condition where tissue from a pregnancy remains inside the uterus after a delivery, miscarriage, or abortion. Healthcare providers have established methods for identifying and managing RPOC to prevent further issues. The presence of this remaining tissue can lead to specific symptoms and potential complications if not addressed.
Causes of Retained Tissue
The primary reason for retained products of conception involves the placenta. After a baby is delivered, the placenta should completely detach from the uterine wall and be expelled. Sometimes, this separation is incomplete, leaving fragments behind. This can happen if the placenta does not fully detach on its own or if parts of it are left behind during a manual removal.
A more complex cause is a condition called placenta accreta. In this situation, the placenta’s blood vessels and tissues grow too deeply into the wall of the uterus. This abnormally deep attachment makes it difficult for the placenta to detach cleanly after childbirth, often resulting in pieces being left behind. Placenta accreta is a serious condition that increases the likelihood of retained tissue and significant bleeding.
Anatomical features of the uterus can also contribute to the retention of tissue. Uterine abnormalities, such as a septate uterus (a uterus divided by a wall of tissue), or the presence of fibroids or polyps can create areas where tissue can become trapped. These structural issues can obstruct the natural process of expelling all contents after a pregnancy ends.
The stage of pregnancy when a delivery or loss occurs can also be a factor. Retained tissue is more commonly associated with pregnancies that end during the second trimester. Additionally, certain uterine procedures can increase the risk. Incomplete evacuation during a surgical abortion or complications from a previous uterine surgery might predispose an individual to RPOC in a subsequent pregnancy.
Symptoms and Diagnosis
One of the most common signs of retained products of conception is abnormal vaginal bleeding. This may present as bleeding that is much heavier than a normal postpartum period, is prolonged, or occurs irregularly. The bleeding may also involve the passage of large blood clots. This happens because the uterus cannot contract down effectively to close off blood vessels while the tissue remains inside.
Beyond bleeding, individuals may experience persistent pelvic pain or cramping that is more intense than typical after-pregnancy discomforts. Another significant indicator can be the signs of an infection developing. This may include a fever, chills, and the presence of a foul-smelling vaginal discharge, which suggests that bacteria have begun to grow in the retained tissue.
A healthcare provider will begin the diagnostic process with a physical examination, which may reveal an enlarged or tender uterus. The most definitive tool for diagnosis is a transvaginal ultrasound to see any remaining tissue. An endometrial thickness of 15 mm or more two weeks after a pregnancy loss can be an indicator.
If a standard ultrasound is unclear, a saline-infusion sonogram can be used to better outline the uterine cavity and any masses within it. Additionally, blood tests may be ordered to measure the level of human chorionic gonadotropin (hCG). After a pregnancy ends, hCG levels should steadily decline; if they remain elevated, it can suggest the presence of persistent placental tissue.
Treatment Approaches
When a small amount of tissue is present and the patient is stable with minimal bleeding and no signs of infection, expectant management may be chosen. This “watch and wait” approach allows the body a chance to expel the remaining tissue on its own. It requires careful monitoring by a healthcare provider to ensure the situation does not worsen.
For cases that require intervention but are not urgent, medical management is an option. This involves using the medication misoprostol. Misoprostol causes the cervix to soften and the uterus to contract, which helps to push out the remaining tissue. This method avoids a surgical procedure but is not effective for everyone.
Surgical management is necessary for patients experiencing heavy bleeding, signs of infection, or when other methods have failed. The traditional procedure is a dilation and curettage (D&C), where the cervix is dilated and an instrument is used to scrape the uterine lining to remove the tissue. While effective, this is a “blind” procedure, meaning the surgeon cannot see inside the uterus.
A more precise surgical technique is hysteroscopic resection. During this procedure, a thin, lighted camera called a hysteroscope is inserted into the uterus, providing a direct view of the inside. This allows the surgeon to see the exact location of retained tissue and remove it with precision. This targeted approach may reduce the risk of damaging healthy uterine tissue and forming scar tissue.
Recovery and Potential Complications
If left untreated, RPOC can lead to significant health issues. The most immediate risks are hemorrhage (severe bleeding) and a serious uterine infection known as endometritis. Over time, the retained tissue can cause inflammation that leads to the formation of intrauterine adhesions, or scar tissue. This condition, known as Asherman’s syndrome, can interfere with future fertility.
It is common to experience some cramping and light bleeding for a few days to a week after a procedure. Patients are advised to rest and avoid strenuous activity for a short period. It is important to contact a doctor if heavy bleeding, severe pain, or a fever develops.
The long-term outlook after treatment for RPOC is positive. Once the tissue is removed and the uterus has healed, most individuals have no lasting effects on their reproductive health. Future pregnancies are not impacted when the condition is diagnosed and managed promptly.