DIAGNOSTIC ACCURACY OF TRANSVAGINAL ULTRASOUND IN CLINICALLY SUSPECTED CASES OF RETAINED PRODUCTS OF CONCEPTION

Abstract

Aim: The aim of this study was to determine the diagnostic accuracy of transvaginal ultrasound (TVUS) in clinically suspected cases of retained products of conception taking histopathology findings as gold standard. The author had already reported the sensitivity for the detection of RPOC using conventional medium frequency (3.5 MHz) probe through transabdominal approach and has tried to assess the improvement in the sensitivity using trans vaginal sonographic approach. This study was not designed to compare efficacy of transabdominal with Trans vaginal sonography for the detection of retained products of conception for which another research project is underway in the same department results of which will be published in due course of time.

Material and Methods: The study was conducted in the Department of Diagnostic Radiology, Lahore General Hospital, Lahore. All patients included in the study were within the age bracket of 15-45 years who attended Emergency and/or Outpatient Department (OPD) from June 2009 to May 2013 and were referred by Gynaecology Department on the suspicion of having Retained Products of Conception (RPOC) on the basis of history and/or clinical examination. Detailed relevant history and physical examination findings were recorded in all the cases. Transvaginal ultrasound with a 7.5 MHz convex array transducer was performed in each of the referred cases. The cases underwent histopathology of the extracted material. The results of transvaginal ultrasound and histopathology were compared taking histopathologic findings as gold standard.

Results: A total of 160 patients with clinical suspicion of Retained Products of Conception were registered during this period. The highest number of patients, i.e 68 (42.5%) were aged between 26-35 years. Out of 160 patients, 85 patients (53.12%) had RPOC on TVUS. After comparison of results of Transvaginal ultrasound with histopathology, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of TVUS were 97.6%, 96.05%, 96.4%, 97.3% and 96.8% respectively.

Conclusion: We recommend TVUS for the evaluation of retained products of conception because it is a highly accurate and convenient imaging modality and can play a significant role in decreasing unnecessary surgical intervention and exploration of uterine cavity hence reducing the attendant possible complications (endometritis, adhesion formation, infertility etc), planning management and estimating patient’s prognosis.