Products of conception

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Micrograph of products of conception. Chorionic villi (right of image) and cartilage, i.e. fetal parts (left of image). H&E stain.

Products of conception, abbreviated POC, is a medical term used for the tissue derived from the union of an egg and a sperm. It encompasses anembryonic gestation (blighted ovum) which does not have a viable embryo.

In the context of tissue from a dilation and curettage, the presence of POC essentially excludes an ectopic pregnancy.

Retained products of conception[edit]

Retained products of conception is where products of conception remain in the uterus after childbirth, medical abortion or miscarriage.[1] Miscarriage with retained products of conception is termed delayed when no or very little products of conception have been passed, and incomplete when some products have been passed but some still remain in utero.[2][3]

After medical abortion[edit]

According to the 2006 WHO Frequently asked clinical questions about medical abortion,[4] the presence of remaining products of conception in the uterus (as detected by obstetric ultrasonography) after a medical abortion is not an indication for surgical intervention (that is, vacuum aspiration or dilation and curettage). Remaining products of conception will be expelled during subsequent vaginal bleeding. Still, surgical intervention may be carried out on the woman's request, if the bleeding is heavy or prolonged, or causes anemia, or if there is evidence of endometritis.

In delayed miscarriage[edit]

In delayed miscarriage (also called missed abortion), the Royal Women's Hospital recommendations of management depend on the findings in ultrasonography:[5]

  • Gestational sac greater than 30-35mm, embryo larger than ~25mm (corresponding to 9+0 weeks of gestational age): Surgery is recommended. It poses a high risk of pain and bleeding with passage of products of conception. Alternative methods may still be considered.
  • Gestational sac 15-35mm, embryo smaller than 25mm (corresponding to between 7 and 9+0 weeks of gestational age): Medication is recommended. Surgery or expectant management may be considered.
  • Gestational sac smaller than 15-20mm, corresponding to a gestational age of less than 7 weeks: Expectant management or medication is preferable. The products of conception may be difficult to find surgically with a considerable risk of failed surgical procedure.

In incomplete miscarriage[edit]

In incomplete miscarriage, the Royal Women's Hospital recommendations of management depend on the findings in ultrasonography:[5]

  • Retained products of conception smaller than 15mm: Expectant management is generally preferable. There is a high chance of spontaneous expulsion.
  • Retained products of conception measuring between 15 and 20mm: Medical or expectant management are recommended. Surgery should only be considered upon specific indication.
  • At retained products of conception measuring over 35 to 50mm, the following measures are recommended:
  • Administration of misoprostol to hasten passage of products of conception.
  • Admission to inpatient care for observation for a few hours or overnight until the majority of the products of conception has passed and bleeding subsided.
  • After apparent failure of misoprostol, a gynecologic examination should be done prior to considering surgical evacuation of the uterus or the patient leaving the hospital.

See also[edit]

References[edit]

  1. ^ Definition: 'Retained Products Of Conception' from MediLexicon. Retrieved Feb 2014.
  2. ^ Hutchon, DJ (June 1997). "Missed abortion versus delayed miscarriage.". British journal of obstetrics and gynaecology 104 (6): 753. doi:10.1111/j.1471-0528.1997.tb11994.x. PMID 9197887. 
  3. ^ MedlinePlus (October 25, 2004). "Abortion – incomplete". Medical Encyclopedia. Archived from the original on April 25, 2006. Retrieved May 24, 2006. 
  4. ^ International Consensus Conference on Non-surgical (Medical) Abortion in Early First Trimester on Issues Related to Regimens and Service Delivery (2006). Frequently asked clinical questions about medical abortion. Geneva: World Health Organization. ISBN 92-4-159484-5. 
  5. ^ a b Clinical Practice Guideline: Miscarriage: Management from Royal Women's Hospital. Publication date: 7 October 2010.