[Management of retained products of conception post abortion]

Abstract

Objectives: Trophoblastic retention is a frequently observed complication following voluntary termination of pregnancy. At present, however, its diagnosis is not codified, and its management varies considerably from one healthcare facility to another. The main objective of this study is to identify the factors that might have motivated the therapeutic decision between the two currently recommended management techniques, namely expectant and revision surgery.

Methods: Retrospective study of prospectively collected data, including patients who presented with trophoblastic retention following an abortion performed at Lille University Hospital between January 2020 and December 2022. Epidemiological, clinico-biological and ultrasonographic characteristics of patients were compared between the two management groups.

Results: Analyses show a linear relationship between endometrial thickness and therapeutic decision, with the rate of repeat surgery increasing with endometrial thickness (P<0.001, OR 1.46 [1,30-1,63]). Plasma chorionic gonadotropin hormone (CGH) assay was also associated with management, with surgical revision more frequent when it was≥750 UI/L (P<0.1).

Conclusions: Endometrial thickness appears to be the main determinant of the therapeutic decision. Nevertheless, further studies are needed to confirm these results and harmonize practices. Conversely, symptomatology does not seem to have any impact on treatment orientation, despite the recommendations on this subject.

Keywords: Abortion; Aspiration endo-utérine; Endometrial curettage; Endometrial thickness; Expectative method; Interruption volontaire de grossesse; Méthode expectative; Rétention throphoblastique; Throphoblastic retention; Épaisseur endométriale.