Sonography-Assisted Management of Suspected Retained Products of Conception upon Completion of the Puerperium: A Prospective Single-Center Study

Objectives: Retained products of conception (RPOC) occur in approximately 1% of term deliveries and may result in bleeding, infection, and reproductive complications. However, early postpartum symptoms and ultrasound findings are often nonspecific, making diagnosis challenging. This study evaluated whether transvaginal sonography performed 6 weeks postpartum can effectively stratify RPOC risk in suspected cases and guide follow-up and management. Methods: In this prospective study, 116 hemodynamically stable women with risk factors for RPOC and without significant symptoms underwent transvaginal ultrasound 6 weeks postpartum. Findings were classified as high, moderate, or low probability based on the presence of an intrauterine mass, endometrial thickness, and vascularity. Low probability cases required no further evaluation, whereas those in the moderate and high probability groups were referred for diagnostic or operative hysteroscopy, respectively. Results: Patients were categorized into high (19%), moderate (28%), and low (53%) probability groups. The prevalence of histologically confirmed RPOC in these groups was 50, 12.5, and 0%, respectively. Compared with prior studies that performed earlier postpartum assessments, evaluation at 6 weeks improved diagnostic accuracy, particularly in moderate probability cases, while predictive values in high and low probability groups remained comparable. Conclusions: Sonographic assessment at 6 weeks postpartum provides reliable risk stratification for RPOC and supports a more conservative management approach in hemodynamically stable women without significant symptoms by deferring imaging and potential interventions until completion of the postpartum period. This approach improves diagnostic accuracy in the moderate probability group while reducing false positives and unnecessary interventions.