Retained Products of Conception

What are retained products of conception?

Retained products of conception (RPOC) refer to tissue that remains in your uterus after a pregnancy ends, for example after an:

• Abortion.
• Miscarriage.
• Vaginal delivery.
• C-section.

The tissue is usually from the placenta, but it can also be tissue from the fetus or embryo.

Are retained products of conception and a retained placenta the same thing?

No. Retained products of conception refer to any type of tissue that remains in your uterus, with the placenta being one type of tissue. RPOC refers to a broader category of tissue.

How common are retained products of conception?

Most women don’t experience retained products of conception after their pregnancies.

What are the symptoms of retained products of conception?

Your body goes through a lot of physical changes during and after pregnancy. Some bleeding and vaginal discharge are normal after a pregnancy ends. But heavy bleeding or blood clots could indicate a medical issue that needs diagnosis and treatment.

Heavy or irregular vaginal bleeding is the most common symptom of RPOC. Other symptoms and signs may include:

• Enlarged and tender uterus.
• Fever.
• Pelvic pain.
• Infection.
• Missed menstrual period (if your period doesn’t return and you aren’t breastfeeding).

What causes retained products of conception?

Retained products of conception happen when tissue remains in your uterus after pregnancy ends, whether through a live birth, abortion or miscarriage. Healthcare providers usually don’t know the exact cause, but they do know some factors increase your risk for retained products of conception.

Who is at risk of having retained products of conception?

The biggest risk factor in having RPOC is if you had it before. This increases the chances that you have it again.

The following factors also increase your risk of having RPOC:

• Placenta accreta.
• Advanced maternal age (older than 35 when pregnant).
• Assisted delivery (delivery using instruments such as forceps or vacuum).
• Second-trimester delivery, miscarriage or abortion (weeks 13 to 26 of pregnancy).
• Failure to progress (FTP) during delivery.
• Nulliparity (a woman who has never given birth).
• Past scarring from uterine surgery like C-sections or D&C (dilation and curettage).
• Having an irregularly shaped uterus.

What happens if RPOC (retained products of conception) aren’t removed?

Complications are possible when RPOC remain in your uterus. Some can become quite serious and have long-lasting effects. Some of those complications are:

• Anemia due to losing too much blood.
• Infection, which can damage your reproductive organs or even cause dangerous complications like sepsis when left untreated.
• Chronic pelvic pain.
• Asherman’s syndrome.

Uterine scarring, or Asherman’s syndrome, is a rare complication, but can increase your risk of certain health conditions.

How are retained products of conception diagnosed?

It can be difficult to diagnose RPOC based on symptoms alone. The symptoms may be similar to other postpartum health conditions. Your provider may use exams, tests or imaging to help them evaluate whether you have RPOC.

Blood and tissue tests

• Human chorionic gonadotropin (HCG) test: This test measures the amount of the HCG hormone in your blood. The placenta produces this hormone. RPOC may cause high HCG levels after pregnancy if pieces of the placenta are still in your uterus.
• Dilation and curettage (D&C): Your provider performs a D&C to determine if there’s tissue retained in your uterus. This procedure is also a treatment option for RPOC.
• Endometrial biopsy: During an endometrial biopsy, a healthcare provider removes a small sample of tissue from your uterus. They send the tissue to a lab to be examined under a microscope. The presence of chorionic villi (placental tissue cells) means there’s still placental tissue in your uterus.

Imaging exams

• Transvaginal ultrasound: This imaging exam uses an ultrasound probe in your vagina to check for a thick uterine lining. It also looks for tissue masses in your uterus.
• Color Doppler ultrasound: This imaging exam provides more detail than a regular ultrasound. It shows how blood flows through your body. It can show whether extra tissue in your uterus still has a blood supply. A blood supply could indicate placental tissue still attached to the wall of your uterus.
• Hysteroscopy: During a hysteroscopy, your healthcare provider inserts a thin, lighted tube through your vagina and cervix into your uterus. They examine the inside of your uterus for abnormal tissue or other problems.

How do you treat retained products of conception?

There are several treatments for RPOC, including:

• Misoprostol: You may receive this medication by mouth or through your vagina. In pregnant women, it helps to induce labor. The medication works by causing your uterus to contract and expel (force out) tissue that remains inside.
• Dilation and curettage (D&C): D&C is a surgical procedure to remove the contents of the uterus. Your healthcare provider dilates (opens) your cervix and uses a curette (usually a small, plastic suction tube) to remove tissue.

Do these treatments have risks?

Both misoprostol and D&C carry rare risks of heavy bleeding and infection. A D&C also carries the risk of uterine perforation (making a hole in the wall of your uterus). Uterine perforation is very rare. The uterine wall usually heals on its own. If the perforation injures other organs, you may need surgery to repair them.

Can retained products of conception come out naturally?

It’s possible. Depending on your individual circumstances, it may be reasonable to wait for retained products of conception to come out on their own or your healthcare provider may recommend removing the remaining tissue. Talk to your healthcare provider to determine the safest treatment based on your specific case.

How can I prevent retained products of conception?

There’s no way to prevent RPOC. But you can make sure your healthcare provider knows your full medical history. You may be at a high risk for RPOC due to past pregnancy complications or surgeries. If that’s the case, your pregnancy care provider will monitor your health closely during and after any future pregnancies.

Will I still be able to have children?

Most women who receive treatment for RPOC can still get pregnant and have healthy pregnancies.

When should I call my doctor?

Seek immediate medical attention if you experience any of the following symptoms after a pregnancy ends:

• Difficulty breathing.
• Heavy vaginal bleeding.
• High fever.
• Nausea and vomiting.
• Severe pelvic pain.