Retained products of conception (RPOC) are the placental and/or fetal tissue that remain in the womb following childbirth, a medical termination of pregnancy or a miscarriage.
After childbirth it is vital for the attending midwife to examine the placenta carefully to check that it is complete, as any tissue left behind can cause serious problems. After a caesarean delivery, in addition to inspecting the placenta, the inside of the womb should be examined by the obstetrician before suturing to ensure that none of the placenta is left behind.
The risk of RPOC is much higher after a termination or miscarriage, as it can be more difficult to determine if all of the placental and fetal tissue has been expelled from the womb. RPOC are reported in 17% of first trimester miscarriages and 40% of late (second trimester) miscarriages, compared to less than 3% of full term deliveries.
One of the most serious risk factors for RPOC is the condition placenta accreta, where the placenta becomes attached to the muscle of the womb and/or to nearby structures such as the bladder. This condition is more common if:
Other risk factors are failure to progress during delivery and instrument delivery.
Women with RPOC may experience a number of symptoms, including:
If an individual has some or all of these symptoms, they should report them to a doctor.
If RPOC are suspected, a patient may have to undergo tests such as a physical examination, laboratory testing, ultrasound, or hysteroscopy (a procedure that lets the doctor look inside the womb using a thin, lighted tube).
Treatment of RPOC will be dependent on the clinical situation. For example, some women may be given misoprostol, a synthetic hormone, which encourages the womb to expel the remaining tissue. However, where there is heavy bleeding, surgery may be required. The procedure, evacuation of retained products of conception (ERPC), is performed under a general anaesthetic. A speculum is inserted into the vagina and the cervix (neck of the womb) is stretched open in order to insert an instrument to remove the remaining tissue from the womb. Some women may be able to go home and return to hospital for the operation in a couple of days, but where the bleeding is particularly heavy, an emergency operation may be necessary.
Other treatments, like fluids and antibiotics, might also be needed.
The clinical negligence team at Penningtons Manches Cooper has experience of acting for clients who have suffered problems arising from failure to diagnose and/or treat RPOC.
Specialist members of the team are happy to provide initial advice and an informal, no obligation conversation with anyone who has concerns about the care they have received.