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. 2025 Mar 11;17(3):e80380.
doi: 10.7759/cureus.80380. eCollection 2025 Mar.

Characteristics and Diagnostic Accuracy of Retained Products of Conception After Delivery vs. Abortion: A Retrospective Cohort Study

Avishalom Sharon  1 , Alex Kalendaryov  2 , Inshirah Sgayer  1 , Susana Mustafa Mikhail  3 , Lior Lowenstein  3 , Ala Aiob  1   3
Affiliations

Characteristics and Diagnostic Accuracy of Retained Products of Conception After Delivery vs. Abortion: A Retrospective Cohort Study

Avishalom Sharon et al. Cureus. .

Abstract

Objective: We aimed to evaluate and compare the characteristics, clinical presentations, sonographic features, and hysteroscopic complications of retained products of conception (RPOC) after delivery versus abortion and to compare the accuracy of diagnosing RPOC in these two conditions.

Methodology: This retrospective cohort study included 226 women aged 17-50 years who underwent hysteroscopy for suspected RPOC following spontaneous or induced abortion or delivery between 2018 and 2021. The diagnosis was based on a routine ultrasound, with a hysteroscopy conducted within one week. Collected data encompassed demographics, obstetric history, sonographic findings, clinical features, operative details, and pathology reports.

Results: Of the 226 women included, 65 (28.8%) had RPOC post-delivery and 161 (71.2%) post-abortion. While age and parity did not differ significantly between the groups, gravidity was higher, and previous abortions were more common among the women post-abortion. Symptomatic presentation differed; bleeding and pain were more common post-delivery, and asymptomatic presentation was more frequent post-abortion. Sonographically, Doppler flow was more prevalent post-abortion. The optimal endometrial thickness cutoffs for predicting RPOC post-abortion and post-delivery were 1.55 and 1.49 cm, respectively.

Conclusions: Our study found significant differences in clinical and sonographic characteristics between women with RPOC after abortion versus delivery, emphasizing the importance of tailored diagnostic and management strategies. Although detection rates and sonographic findings varied, routine sonographic assessment is crucial, especially post-abortion. Endometrial thickness proved a reliable predictor for RPOC in both groups.

Keywords: diagnostic accuracy; hysteroscopy; post-abortion; post-delivery; residual placenta; sonographic features.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. ROC curve analysis evaluating the association between endometrial thickness, as measured by transvaginal sonography, and the detection of retained products of conception following abortion.
ROC, receiver operating characteristic
Figure 2
Figure 2. ROC curve analysis evaluating the association between endometrial thickness, as measured by transvaginal sonography, and the detection of retained products of conception following delivery
ROC, receiver operating characteristic
See this image and copyright information in PMC

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