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INCOMPLETE ABORTION |
- Retained products of conception (chorionic villi = placental tissue and trophoblastic = fetal tissue remaining within the uterus).
- Clinical signs:
- Prolonged bleeding.
- Infection.
ULTRASOUND |
(Accuracy ±96%)
Finding |
Retained Products |
|
Gestational
sac/collection |
100% |
· Variable appearance on ultrasound:
o Normal
o Mass of mixed echogenicity.
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· Color doppler is very useful because of the varied appearance. The presence of a prominent vascular supply and feeding vessel helps make the diagnosis. In more chronic cases the retained products may be avascular.
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COMPLICATIONS |
- Endometritis, myometritis, peritonitis, septic shock, diffuse intravascular coagulopathy (DIC) with retention >1 month.
- Endometritis – endometrium appears prominent, irregular or both, usually with a small amount of endometrial fluid. Clinically the patients present with severe pelvic pain.
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Neilson and Hahlin (1995) (1):
- Randomized prospective trial of 103 women with retained products of conception (RPOC) measuring 15-50 mm.
- 71% success rate in expectant management.
- Complication rate (measured by the number of infections or the development of anemia):
- 3% on the expectant group.
- 11% in the surgical group.
- Duration of bleeding in the expectant group was 1.3 days longer (P<0.02).
- No difference in pain or packed cell volume in each group.
Failure to resolve the miscarriage was most likely when gestational sac was intact and the cervix was closed. Resolution in these patients may take several weeks and up to 20% will opt for surgical evacuation. The rate of spontaneous completion depends on the type:
|
Classification |
Complete miscarriage |
Successful outcome by day 46 |
|
|
By
day 7 |
By
day 14 |
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Incomplete
abortion |
53% |
84% |
91% |
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Missed
abortion |
30% |
59% |
76% |
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Anembryonic
pregnancy |
25% |
52% |
66% |
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Adapted from: Luise C, Jermy K, Collins WP, Bourne TH. Outcome of expectant
management of spontaneous first trimester miscarriage: observational study.
BMJ 2002;324:873-875. |
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Other authors have reported success rates for expectant management of as low as 24.7 % (2).
Luise and Jermy (3):
- Neither the presence of a gestational sac within the uterine cavity nor the thickness of the endometrium is clinically useful in determining outcome of expectant management.
- The number of days taken to complete a miscarriage and the proportion of women completing their miscarriage in relation to time is not related to the initial ultrasound findings.
- Data suggests that follow up for women with incomplete miscarriage need not include sonography.
REFERENCES |
- Neilson S, Hahlin M. Expectant management of first trimester
spontaneous abortion. Lancet 1995;345:84-86.
- Jurkovic D, Ross JA, Nicolaides KH. Expectant management of
miscarriage. Br J Obstet Gynaecol 1998;105:670-671.
- Luise C, Jermy K, Collins WP et.al. Expectant management of incomplete, spontaneous first-trimester miscarriage; outcome according to initial ultrasound criteria and value of follow up visits. Ultrasound Obstet Gynecol 2002;19:580-582
- Condous G, Okaro E, Bourne T. The conservative management of early pregnancy complications. Ultrasound Obstet Gynecol 2003;22:420-430.