Correlation of transvaginal sonography and hysteroscopy in the detection of retained products of conception immediately after suction evacuation in first-trimester

Abstract

Introduction: Retained products of conception are a frequent outpatient dilemma faced by gynecologists.Blind dilatation and curettage can lead to endometritis, perforations and hemorrhage.We aimed to study the correlation of transvaginal sonography (TVS) and hysteroscopy in the detection of retained products of conception (RPOC) immediately after dilatation and suction evacuation (S and E) in first-trimester abortion. Materials and Methods: This was a prospective observational study conducted at the gynecology department in a university-affiliated hospital. All women with a diagnosis of intrauterine RPOC by TVS showing a heterogeneous intrauterine sac of more than 15 mm thickness, without endometritis, treated with S and E for RPOC, who also underwent subsequent hysteroscopy and TVS ,were enrolled in the study. Results: Since no literature is available comparing these two modalities directly, 50 cases as a pilot study were studied. TVS findings of RPOC with endometrial thickness >15 mm and hyperechoic area or area of mixed echogenicity along with hysteroscopy findings of RPOC were tabulated and correlated. The strength of agreement between TVS and hysteroscopy was determined. In our study, 28% of the participants who had S and E done for first-trimester abortion had RPOC on TVS. The sensitivity and specificity of RPOC on TVS were 69.2% and 86.5%, respectively, with a positive predictive value of 64.3%. Twenty-six percent of the participants had RPOC on hysteroscopy who later underwent re-evacuation procedure using operative hysteroscopy. Conclusion: Hysteroscopy is the gold standard for removal of RPOC. A combination of TVS and hysteroscopy for detection of RPOC would lower rates of complications and postoperative intrauterine adhesions.

Keywords

• abortion
• hysteroscopy
• retained products of conception