Factors associated with intrauterine procedure for suspected retained placenta after medical termination of pregnancy in the 2nd and 3rd trimesters

Abstract

Introduction: In cases of medical termination of pregnancy (MTOP) in the second and third trimesters, incomplete placental expulsion is a common complication, often leading to intrauterine procedure. Factors associated with intrauterine procedure for suspected retained placenta after labor induction for MTOP remain poorly described. Moreover, these procedures may lead to various complications (uterine perforation, infections, secondary bleeding, intrauterine adhesions, fertility disorders). This study aims to identify these factors to support a more evidence-based use of intrauterine procedures.

Materials and methods: A retrospective single-center study was conducted at Toulouse University Hospital, between January 1, 2019, and December 31, 2021. All patients who underwent labor induction for MTOP between 14 and 41 weeks of gestation were included. Maternal, obstetric, and fetal characteristics were collected and analyzed.

Results: A total of 371 patients were included. Gestational age was the only factor significantly associated with the performance of intrauterine procedures for suspected retained placenta (continuous variable (aOR 0.84 [0.80-0.88], p < 0.0001) and categorical variable divided into <22 weeks and ≥22 weeks of gestation (OR 0.15 [0.10-0.24], p < 0.001)).

Discussion: Identifying factors associated with intrauterine procedures after MTOP in the 2nd and 3rd trimesters could lead to modified management strategies, based on gestational age, which is associated in this study, with a lower likelihood of performing intrauterine procedures beyond 22 weeks.

Conclusion: Gestational age was associated with the performance of intrauterine procedures for suspected retained placenta after MTOP, with a lower likelihood beyond 22 weeks of gestation.

Keywords: Complications; Gestational age; Intrauterine procedure; Medical termination of pregnancy; Retained placenta; Ultrasound.