The Diagnostic Accuracy of Ultrasound in Retained Products of Conception in Postpartum Period by Using Histopathology as the Gold Standard

Abstract

Background: Retained product of conception (RPOC) has been the commonest factor involved in secondary post-partum hemorrhage. Ultrasound is a valuable diagnostic method for the diagnosis of PPH patients and is much more reliable than clinical presentation for the RPOC diagnosis alone. Objective: To determine the diagnostic accuracy of ultrasound in detection of retained products of conception in postpartum period in clinically suspected patients taking histopathology as gold standard. Study Design: Cross-sectional study. Settings: Radiology Department, Civil Hospital, Karachi Pakistan. Duration: From 5th February 2017 to 4th August 2017. Methodology: Total 135 patients with clinical suspicion of retained product of conception were included. Sonography was performed. D & C was performed and specimen sent for histopathology. The diagnostic accuracy of ultrasound was established regarding specificity, sensitivity, NPV, PPV, against histopathology. Post stratification chi square test was applied and p-value ≤0.05 was considered as significant. Results: The mean age of patients was 31.84±7.91 years. Mean duration of symptoms was 3.48±1.44 weeks. By ultrasound, 64.4% were diagnosed retained products of conception and by histopathology 54.8% were diagnosed. There were 65 true positive patients and 39 true negative patients. Specificity, Sensitivity, NPV, PPV, and accuracy were 63.9%, 87.8%, 81.2%, 74.7%, and 77% respectively. Conclusion: Ultrasonography was observed as a reliable diagnostic tool showed accuracy rate of 77.0% with 87.8% sensitivity and 63.9% specificity, in the diagnosis of retained products of conception (RPOC).