Retained products of conception: a minority has third-stage labor complications

  • Eur J Obstet Gynecol Reprod Biol

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Women with third stage of labor placental complications are at increased risk for retained products of conception (RPOC) but represent a minority of all patients at risk for surgically treated RPOC.

Why this matters

  • RPOC affects 1% of deliveries and is associated with postpartum hemorrhage (PPH) and endometritis.

Key results

  • 4.8% of women who had vaginal deliveries were treated for third stage of labor placental complications.
  • 0.5% underwent a surgical procedure for RPOC:
    • operative hysteroscopy (83.1%);
    • suction curettage (16.9%).
  • Among the women who had surgical treatment for RPOC, 37.8% reported third stage of labor complications.
  • Women with third stage of labor complications had higher rates of surgically treated RPOC compared with controls (3.7%; OR, 12.5; 95% CI, 9.0-17.3).
  • Postoperative pathology was consistent with RPOC in 62.8% of cases.
  • No differences in demographics between groups; risk factors were vaginal bleeding, suspected endometritis, and suspicious US findings in asymptomatic women (all P=.004).

Study design

  • Retrospective cohort study.
  • Women with RPOC following vaginal delivery were identified through an electronic database using ICD codes and compared with a control group.
  • Funding: None disclosed.

Limitations

  • Some patients may have been treated for RPOC at other hospitals, and the incidence of this complication may have been underestimated.