Postpartum endometritis with retained products

Question 1

What are 3 situations when women might present with retained products?

Answer 1

1. Conservative or medical management of miscarriage (sometimes following surgical management)
2. After normal delivery
3. After termination of pregnancy

Question 2

What are 7 features of the presentation of retained products of conception?

Answer 2

1. Persistent bleeding for 3 or more weeks post-delivery/TOP
2. Offensive discharge
3. Raised temperature
4. Low blood pressure
5. Uterine tenderness
6. Cervical excitation
7. Positive pregnancy test

Question 3

Why is the pregnancy test positive in a woman wit retained products of conception?

Answer 3

due to presence of trophoblastic tissue retained in the uterus

Question 4

What are 5 possible blood tests to order in a women with suspected retained products of conception?

Answer 4

1. FBC
2. Group and save including Rhesus status
3. U+E
4. CRP
5. Clotting screen

Question 5

In what setting are most patients with RPC managed?

Answer 5

outpatient setting with involvement of the gynae team

Question 6

What investigation will confirm the diagnosis of RPC?

Answer 6

transvaginal USS

Question 7

What are 3 aspects of te management of RPC?

Answer 7

1. Surgical evacuation of RPC (sometimes conservative or medical management)
2. Start oral antibiotics if clinical concern about infection
3. If evidence of sepsis, resus, IV antibiotics, inpatient tx

Question 8

After which type of termination of pregnancy is RPC more common?

Answer 8

medical abortion

but also surgical at either very early or later gestations

Question 9

What is the management of RPC following termination of pregnancy?

Answer 9

some women will require (furter) surgical evacuation of the uterus, particularly if heavy or prolonged bleeding

some women will pass the retained tissue spontaneously without need for further intervention

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