Retained Products Of Conception Research Articles

Multidetector CT appearance of the pelvis after vaginal delivery: normal appearances and abnormal acute findings.

Vaginal delivery is the most commonly performed delivery in the world and accounts for nearly two-thirds of all deliveries in the United States. It is a secure method but may be associated with some acute complications, especially in the immediate postpartum days, which can potentially be fatal for the mother. The most frequent acute complications are hemorrhages/hematomas, uterine rupture, endometritis, retained product of conception (RPOC), ovarian thrombosis and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). A first evaluation of the clinical status of the patients is executed by the clinicians who, depending on their experience, perform ultrasonography by themselves and eventually may request further radiologic exams in doubtful cases. Radiologists may play an important role recognizing early postpartum complications and differentiating them from physiologic postoperative findings. In this setting, the use of multidetector computed tomography (MDCT) is important for diagnosis of suspected postpartum complications. The aim of this article is to review the normal and abnormal post vaginal delivery MDCT aspects in order to help the clinical management by preventing misdiagnoses and tailoring the best medical treatments.

Ultrasonographic vascularity assessment for predicting future severe hemorrhage in retained products of conception after second-trimester abortion

Objectives: To investigate the spontaneous outcomes of vascularized retained products of conception (RPOC) detected by ultrasonography after second-trimester abortion, and to identify the predictive factors for the development of severe postpartum hemorrhage (SPPH).Study design: This is a retrospective cohort study on all cases after second-trimester abortion managed at our institute between January 2014 and December 2016. We assessed the associations between the occurrence of SPPH requiring invasive treatment and clinical factors including ultrasonographic findings (size and the vascularity status of RPOC classified as follows: type 1: vascularity confined to endometrium, type 2: vascularity reaching <1/2 myometrium, and type 3: vascularity reaching ≥1/2 myometrium) in vascularized RPOC cases.Results: Among 103 cases after second-trimester abortion, 19 patients (18.4%) were diagnosed as RPOC, and five patients eventually failed expectant management due to SPPH. Of them, 66.7% (4/6) of patients with type 3 developed SPPH as compared with 7.7% (1/13) of patients with type 1/type 2 (p < .05). The maximum vascularized mass diameter was significantly greater among the five patients who experienced SPPH than among the 14 patients who demonstrated spontaneous remission (43.0 ± 12.0 mm versus 20.7 ± 8.3 mm, p < .01). Patients with type 3 RPOC and a maximum vascularized mass diameter ≥30 mm, compared with other patients, demonstrated sensitivity, specificity, and risk ratio related to SPPH of 80, 92.9%, and 11.2, respectively.Conclusions: Our findings suggest that the ultrasonographic assessment of RPOC focused on the depth of vascularity in combination with the measurement of its size appears to be essential in determining women with RPOC who are at high risk for SPPH.

Postpartum retained products of conception: Retrospective analysis of the association with third stage of labor placental complications

ObjectiveTo compare the prevalence of postpartum retained products of conception (RPOC) among parturients with a history of third stage of labor placental complications and parturients without those complications. Study designAll women operated for postpartum RPOC following vaginal delivery by hysteroscopy or suction curettage between January 2013 and December 2017 were included in the study. Their medical records were reviewed for the occurrence of third stage of labor placental complications (including early postpartum hemorrhage treated with uterotonics, manual separation of the placenta, and revision of the uterine cavity for removal of cotyledons). ResultsThe study cohort included 172 women operated for postpartum RPOC following vaginal delivery by operative hysteroscopy (143 cases, 83.1%) or by suction curettage (29 cases, 16.9%). Third stage of labor placental complications were reported in 65 (37.8%) cases, while 107 (62.2%) women had an uncomplicated third stage of labor. When considering all vaginal deliveries in our institution during the study period, the risk for RPOC was significantly higher among parturients with third stage of labor placental complications compared to those with an uneventful third stage of labor (3.7% versus 0.3%, p < 0.001, Odds ratio = 12.5, 95% confidence interval 9.0–17.3). ConclusionPostpartum RPOC following vaginal delivery were more common in parturients with third stage of labor placental complications. However, the majority of postpartum RPOC cases were diagnosed in women reported to have an uncomplicated third stage of labor. Thus, focused postpartum ultrasound follow-up of women considered at risk for RPOC will not identify all cases.

Operative hysteroscopy for retained products of conception: Efficacy and subsequent fertility

Retained product of conception complicates nearly 1% of pregnancies and can lead to synechiae and compromise ulterior fertility. The aim of this study is to evaluate efficiency of operative hysteroscopy in management of retained products of conception (RPOC). Secondary objectives are assessments of intra-uterine adhesions rate and later fertility.This unicentric retrospective study includes women who undertook an operative hysteroscopy for retained products of conception between January 2012 and March 2014. Assessment of the efficiency of operative hysteroscopy is defined by a complete resection of retained products of conception confirmed by office hysteroscopy.One hundred fourteen women were included in the study. Efficiency of operative hysteroscopy for retained products of conception is 91% for women with a postoperative office hysteroscopy. The authors observed a 7.5% rate of postoperative intra-uterine adhesions. Fertility rate was 83% (30 women out of 36 with a desired pregnancy).Hysteroscopic resection of retained products of conception is an efficient procedure and seems to be a real alternative.

Diagnostic Accuracy of Ultrasound in Detecting Retained Products of Conception: A Study from a Tertiary Care Hospital in Karachi, Pakistan.

IntroductionRetained products of conception (RPOC) are a known complication after abortion or childbirth. To improve clinical evaluation and avoid unnecessary surgery, transvaginal scan is performed in suspected cases. However, both RPOC and blood clots appear isoechoic on ultrasound, and false positives can lead to unnecessary intervention. In this study, the ultrasound findings have been correlated with the histopathology (as a gold standard) to determine the diagnostic value of sonography in the detection of RPOC in postpartum or post-abortion patients.MethodsThis cross-sectional study was carried out to determine the diagnostic accuracy of ultrasound in the detection of the retained products of conception in relation with the histopathological findings at the Department of Radiology, Aga Khan University Hospital (AKUH), Karachi.A total of 193 patients with suspicion of RPOC undergoing a transvaginal scan in the Department of Radiology, AKUH, were enrolled. The study was conducted for a period of 12 months from October 2014 to October 2015.ResultsOur results yielded that out of 193 cases, 113 cases (87.05%) had histopathology positive for RPOC, while 107 (55.44%) RPOC cases were identified by ultrasound as having RPOC. The mean endometrial thickness of the patients included in the study was 13.5 mm. According to our results, ultrasound has a sensitivity of 75.22%, specificity of 72.50%, a positive predictive value (PPV) of 79.44%, a negative predictive value (NPV) of 67.44%, and a diagnostic accuracy of 74.09%.ConclusionTransvaginal ultrasound is a modality that can be used for early diagnosis of the retained products of conception including fetal parts and could prove to be lifesaving. However, the operator and equipment variables need to be looked at, and a uniform criterion needs to be agreed on.

Hysteroscopic Management of Retained Products of Conception

Objective: Retained products of conception (RPOC) defined as persistent trophoblastic tissue within the uterine cavity is an uncommon condition that should be considered in the presence of abnormal uterine bleeding after an abortion, vaginal delivery or cesarean section. The traditional approach for the treatment of RPOC with dilatation and curettage (D&C) is currently being displaced by hysteroscopic management.

655 - Appended Benefits of Office Hysteroscopy in Managing Retained Products of Conception (RPOCs)

655 - Appended Benefits of Office Hysteroscopy in Managing Retained Products of Conception (RPOCs)

Hysteroscopic tissue removal system (MyoSure) for the resection of polyps, sub-mucosal leiomyomas and retained products of conception in an out-patient setting: A single UK institution experience

PurposeThe present study aimed to elucidate the hysteroscopic tissue removal system (MyoSure) efficacy and safety amongst uterine cavity pathologies (UCPs), and to determine its feasibility in an outpatient setting. We also sought to identify possible factors that could adversely affect complete lesion excision. Methods124 women underwent MyoSure procedure and 135 UCPs were excised, between January 2017 and January 2018. The MyoSure efficacy was evaluated, and potential factors correlated with increased incomplete excision rate were assessed, using both univariate and multivariate analysis. ResultsThe overall MyoSure excision rate was 94.8%. 107/109 polyps and 14/19 leiomyomas were completely resected with a success rate of 98.1% and 73.7% respectively. The complete excision rate amongst retained products of conception (RPOC) cases was 100%. A significant correlation between leiomyomas and incomplete excision was found when compared to polyps and RPOC (p < 0.001). In this cohort, type II leiomyomas (OR = 1.8, p = 0.01) and maximal diameter > 4 cm (OR = 1.6, p = 0.02) were independently correlated with incomplete leiomyomas excision. Nine out of 124 women (7.3%) experienced severe pain during the procedure, while 17% and 73% reported moderate and mild pain respectively. Furthermore, 99% of women (123/124) would undergo the procedure again in the future or recommend it to a friend, for a similar pathology removal. ConclusionsMyoSure is an efficient, safe and feasible operative hysteroscopic procedure in an office-outpatient setting. It is associated with high patient acceptability and, it is highly recommended by the vast majority of the women. Large, and type II leiomyomas are seemingly procedure limitations.

Fertility outcome after treatment of retained products of conception: a systematic review

BackgroundTreatment of retained products of conception (RPOC) can be expectant, medical or operative. Surgical removal of RPOC may lead to intrauterine adhesions (IUA) and Asherman’s syndrome.ObjectiveTo evaluate how treatment options for RPOC affect future fertility by means of a systematic review.Search strategyMEDLINE, EMBASE, The Cochrane Library, and clinical trial registers were searched, and reference lists were scanned.Selection criteriaRandomised controlled trials (RCT) comparing different treatment options for RPOC (conservative, medical or surgical treatment, including curettage and/or hysteroscopic techniques, with or without application of anti-adhesion therapy), in women of reproductive age, were eligible for inclusion.Data collection and analysisReviewers independently performed data extraction and quality of evidence assessment. For dichotomous variables, results were presented as risk ratio (RR) with 95% CI.Main resultsTwo studies were included. Nonsignificant differences were observed between the use of an anti-adhesion barrier gel versus no treatment after operative hysteroscopy in IUAs (RR 0.32, 95% CI 0.04 to 2.80, P value = 0.30) and clinical pregnancy (RR 2.22, 95% CI 0.67 to 7.42, P value = 0.19), and between hysteroscopic morcellation versus loop resection in IUAs (RR 0.86, 95% CI 0.06 to 13.12, P value = 0.91).ConclusionThere is insufficient evidence on how different treatment options for RPOC affect future reproductive outcomes. Results from ongoing RCTs are needed to guide clinicians towards choosing the best treatment.

Pregnancies Following Hysteroscopic Removal of Retained Products of Conception after Delivery Versus Abortion

Aim: To compare clinical variables, sonographic findings and pregnancy outcomes following the hysteroscopic removal of retained products of conception (RPOC) after delivery and abortion. Methods: This is a retrospective cohort of operative hysteroscopies performed between 2011 and 2015 for suspected RPOC, during which trophoblastic tissue was obtained. Patient demographics, clinical presentation, sonographic evaluation, subsequent infertility and pregnancy outcomes were compared between post-delivery (n = 85) and post-abortion (n = 93) cases. Results: The main presenting symptom in both study groups was vaginal bleeding. On sonographic evaluation, maximal endometrial thickness was significantly higher in the post-delivery group, while irregularity and increased flow were more common in the post-abortion group. There was a similar rate of deliveries following hysteroscopy in both groups with 40% in the post-delivery group and 39.7% in the post-abortion group. Deliveries in the post-delivery group were characterized by a higher rate of abnormal placentation – 30.5% – including low lying placenta and placenta accreta. A significant rate of vaginal deliveries in both groups entailed manual removal of the placenta or exploration of the uterine cavity (23.5 and 10.5%, p = 0.20). Conclusion: Pregnancies following RPOC after delivery entail a higher rate of abnormal placentation.

Six-month recovery needed after dilation and curettage (D and C) for reproductive outcomes in frozen embryo transfer

In this study, the endometrial developmental and reproductive outcomes of frozen embryo transfers (FETs) which were performed subsequent to miscarriages managed by dilation and curettage (D and C) were investigated. The intracytoplasmic sperm injection (ICSI) blastocyst freeze-all cycles performed between January 2014 and August 2016 were screened for the patients who had undergone their FET (first), miscarriages (>5 < 14 weeks), D and C, and the patients who had undergone their FET (second) (study group; n = 71); and patients who underwent FET (1st), a chemical pregnancy loss (PL) (<5 weeks) and FET (2nd) (reference group; n = 38). The live births (LB; delivery >20 weeks) of FET (2nd) were analysed in two time-interval sub-groups: ≤6 months or >6 months. In the study and reference groups, the median endometrial thickness at the second FET of the ≤6 months sub-groups was found to be significantly reduced. The relative risk for LB was significantly higher (1.65 [0.994–2.723] p = .043) in the >6 months study sub-group, with a lower risk for PL (0.62 [0.268–1.427] p = .329), whereas, there were no significant differences between the reference sub-groups. The management of miscarriage with D and C results in a significant and transient decrease in reproductive function in subsequent FET.Impact StatementWhat is already known on this subject? Approximately, 15–30% of positive pregnancies in assisted reproductive technology (ART) end in biochemical pregnancy losses (PLs) or miscarriages. Cervical dilation with suction or blunt curettage (D and C), has been the procedure most often used to manage the retained products of conception (RPOC) after miscarriage. Intrauterine surgery has the potential to directly affect reproduction, depending on the endometrial impact.What the results of this study add? The endometrium after D and C surgery may require 6 months to recover normal reproductive function, in terms of both live birth and PL. The extent of the damage to endometrial function is not found to be reflected in the endometrial thickness.What the implications are of these findings for clinical practice and/or further research? Patients who undergo miscarriage after their ART treatment may need to delay further treatment for 6 months to optimise their chances of LB. Alternative miscarriage management procedures need to be investigated; procedures that have lower risks for an adverse reproductive function and allow for shorter time intervals between treatments.

Evaluation of retained products of conception using pulsed continuous arterial spin-labeling MRI: clinical feasibility and initial results.

We evaluated the vascularity of retained products of conception (RPOC) using arterial spin-labeling magnetic resonance imaging (ASL-MRI) to clarify the clinical feasibility of this approach. A pulsed-continuous ASL sequence with echo-planar imaging (EPI) acquisitions was used. Ten consecutive patients with RPOC were enrolled. All ASL images were evaluated visually and semiquantitatively and compared with the findings of Doppler ultrasound (US) and dynamic contrast-enhanced MRI (DCE-MRI). The technical success rate was 93.7% (15/16 scans). One failed case was excluded from the analysis. Six patients showed quite high signals over RPOC, while three patients showed no abnormal signals. Doppler US alone failed to detect the hypervascular area in two cases, and ASL-MRI alone failed in three. A significant linear correlation was found between semiquantitative values of ASL-MRI and DCE-MRI. All six patients showing high signals on ASL-MRI underwent follow-up MRI after therapy. High signals in five patients decreased visually and semiquantitatively, while one patient showed signal increases. Evaluation of RPOC using ASL-MRI was clinically feasible and response to therapy could be evaluated. However, the clinical advantages over conventional imaging remain unclear and need to be evaluated.

Retained products of conception: What is the risk for recurrence on subsequent pregnancies?

ObjectiveTo investigate whether women who were surgically treated for retained products of conception (RPOC) by either suction curettage or hysteroscopy are at risk for recurrent RPOC on their subsequent pregnancies. Study designRetrospective analysis of 442 women surgically treated for RPOC following delivery or abortion by suction curettage (N = 63, 14.3%) or hysteroscopy (N = 379, 85.7%). Information on subsequent pregnancies and their outcomes was available for 161 (36.4%) women. ResultsOne or more live births were reported for 150 (93.2%) of the women for whom information on subsequent pregnancies was available. The overall rate of spontaneous abortions was 31/161 (19.3%). Recurrent RPOC were diagnosed in 25 (15.5%) cases, while third stage of labor placental problems (including retained placenta or cotyledons and placenta accreta) were found in 44 (27.3%) cases. Recurrent RPOC was associated with treatment by suction curettage compared with hysteroscopy for the initial RPOC on multivariate logistic regression analysis (Odds Ratio [OR] = 3.6, 95% Confidence Interval [CI]1.3–10.5, p = 0.01) and with the initial RPOC occurring after delivery compared with after abortion (OR = 8.4, 95%CI 1.8–39.5, p = 0.006). ConclusionWomen treated for RPOC are at risk for recurrent RPOC and for third stage of labor placental problems on their subsequent pregnancies, especially those who had been managed by suction curettage in comparison with operative hysteroscopy. Clinical and ultrasound follow-up in the early and late postpartum period should be considered in women with a history of RPOC.

Oral contraceptive pills as an option for non-surgical management of retained products of conception – a preliminary study

Many Patients with persistent retained products of conception prefers to avoid surgical interventions, such as a dilatation and curettage (D&C) that might pose an additional future risk to their already compromised fertility or obstetric performance. The aim of this study was to the possibility of induced withdrawal bleeding following oral contraceptive administration as a non-surgical treatment for patients with persistent retained products of conception (RPOC). A retrospective study of patients presenting with retained products of conception (RPOC) after failed expectant management or after treatment with PGE1 was performed. Twelve women presenting with RPOC at ≤8 weeks gestation with minimal to mild vaginal bleeding and no signs of infection were treated with oral contraceptive pill (OCP) containing 0.03 mg ethinylestradiol and 0.15 mg of desogestrel for 3 weeks. Out of the 12 patients treated, nine women (75%) successfully expelled the RPOC after completing the three-week course of OCPs. The three cases (25%) that did not resolve following OCP treatment had pregnancy products with positive blood flow on Doppler examination. We conclude that OCPs may be a useful medical treatment option for persisting RPOC in selected patients with absence blood flow on Doppler examination wishing to avoid surgical intervention.

A prospective descriptive study of the management of miscarriages at two tertiary hospitals in Zimbabwe: variations from global trends

Background: Early pregnancy loss is the commonest reason for admission to gynaecological wards for women of reproductive age group.Objective: To assess the current management of incomplete miscarriage at Harare and Parirenyatwa Hospitals and to determine the proportion of patients with incomplete miscarriage managed with Manual Vacuum Aspiration (MVA), sharp curettage or medical evacuation.Design: A prospective descriptive study.Setting: Two teaching hospitals in Zimbabwe.Materials and Methods: Women admitted with incomplete miscarriage, missed, septic incomplete and complete miscarriage were followed up from admission until discharge between for April and May in 2014. Demographic details, management and clinical course was recorded prospectively on a form.Main Outcome Measures: Outcome assessed were method of evacuation, need for transfusion, antibiotic use and hospital stay.Results: Four hundred and eleven (411) women were admitted to the two hospitals. The mean gestation at admission was 12 weeks. Planned pregnancies were 62.3% with 37.8% unplanned. Those who used contraception prior to conception were 22%. Only 5.4% were diagnosed as septic and 2 patients (0.5%) had foreign bodies in the genital tract. The majority of patients had sharp curettage for evacuation of retained products of conception with very few patients being having MVA, suction curettage, expectant management or medical evacuation. Overall only 0.5% of patients had medical evacuation. The mean duration of hospital stay was 27 and 19 hours for Parirenyatwa and Harare respectively and was not statistically significant.Conclusion: We have shown that most patients are still having sharp curettage in theatre despite Zimbabwe being one of the countries to introduce MVA in early 1990s. Management of incomplete miscarriage has not kept up with global trends where suction blunt curettage is the preferred method

Multimodality imaging in secondary postpartum or postabortion hemorrhage: retained products of conception and related conditions.

Secondary postpartum hemorrhage (PPH) and postabortion hemorrhage are rare complications. Retained products of conception (RPOC) is among the most common causes of both secondary PPH and postabortion hemorrhage. Other less common causes of secondary PPH are uterine vascular abnormalities such as arteriovenous malformations and pseudoaneurysms. These are usually related to a history of a procedure such as dilation and curettage or cesarean delivery. Subinvolution of the placental site is an idiopathic cause of secondary PPH; this condition may be underrecognized and therefore could have a higher incidence than currently reported. Gestational trophoblastic disease is rare but commonly presents as secondary PPH and resembles RPOC in radiologic appearance. The first-line imaging modality for secondary PPH is ultrasound, but computed tomography and magnetic resonance imaging may be used if the ultrasound findings are indeterminate. Angiography is an important tool for the definitive diagnosis of uterine vascular abnormalities. Appropriate management requires radiologists to be familiar with the multimodality imaging features of secondary PPH or postabortion hemorrhage.

Office hysteroscopy for removal of retained products of conception: can we predict treatment outcome?

Purpose of investigation: To evaluate the safety and efficacy of office hysteroscopy in the management of retained product of conception (RPOC) and to identify those predictors for treatment success. Study Design: A retrospective cohort study that was conducted in tertiary university-affiliated medical center. One hundred and eight women with sonographic findings of RPOC, who underwent seeand-treat hysteroscopy, were included in this study. Demographic data, indication for treatment, and preoperative patient characteristics and ultrasound findings were evaluated as predictors for treatment outcome. Results: Office-hysteroscopy was well tolerated by most of the patients (96%), with an overall success rate of 65%. Causes of treatment failure were: actual RPOC size (assessed during seeand-treat hysteroscopy), bleeding, and pain. In univariate analysis, none of the examined factors was shown to predict complete removal of RPOC. Furthermore, RPOC size assessed by ultrasound was not shown to be valuable predictors for treatment outcome. Conclusions: The efficacy of office hysteroscopy for removal of RPOC is limited. Ultrasound measurement of RPOC size should not be used as a predictor for treatment outcome.

Postpartum Retained Products of Conception: A Novel Approach to Follow-Up and Early Diagnosis.

To investigate whether ultrasound follow-up for the detection of postpartum retained products of conception (RPOC) in women considered at risk for this condition may allow for early diagnosis. Parturients at risk for RPOC underwent an ultrasound exam on the second postpartum day. Based on the ultrasound findings, women were either: (1) discharged to routine postpartum care in cases of normal scans, (2) invited for follow-up in cases of abnormal scans. We retrospectively analyzed the rates of women requiring uterine evacuation due to persistent abnormal scans. 761 parturients (out of 17 010 deliveries, 4.5 %) were included. Of those, 490 (64.4 %) women had a normal initial scan, but two of them were later readmitted for uterine evacuation. The remaining 271 (35.6 %) women were found to have an abnormal scan: (a) thickened endometrium > 10 mm with hypo- and hyper-echoes and negative Doppler flow considered low suspicion for RPOC was described in 260cases, of whom 23 (8.8 %) underwent uterine evacuation with placental remnants confirmed in 12/23 (52.2 %), and (b) an echogenic mass with positive Doppler flow considered high suspicion for RPOC was described in 11 cases, all ofwhom underwent uterine evacuation, with placental remnants confirmed in 9/11 (81.8 %). The number of scans required to detect RPOC in one patient was 33. Postpartum ultrasound evaluation may allow for early diagnosis of RPOC in women considered at risk for this condition.

Risk factors and complications of manual placental removal after vaginal delivery – how common are additional invasive procedures?

Purpose: The purpose of this study is to assess risk factors and complications of manual placental removal. Materials and methods: An historical prospective study of all parturients undergoing manual placental removal between 2012 and 2014. Parturients were matched by time of delivery with parturients delivering vaginally with spontaneous placental separation. Multiple gestations, preterm deliveries, incomplete placental separation and uterine malformations were excluded. Delivery characteristics and short-term complications were studied. Telephone questionnaires were conducted to assess the likelihood of invasive procedures performed for retained products of conception (RPOC) up to 12 weeks postpartum. Results: Overall 293 (1.5% of all vaginal deliveries) were complicated by manual placental removal. Independent risk factors included advanced maternal age (odds ratio (OR) 1.08, 95% CI 1.03–1.12), previous manual removal (OR 9.27, 95% CI 3.15–27.31), regional anesthesia (OR 3.49, 95% CI 2.14–5.70), and labor induction (OR 1.80, 95% CI 1.12–2.88). Short-term complications included blood product transfusions (OR 18.26 95% CI 5.37–62.13) and prolonged hospitalization (OR 1.51 95% CI 1.06–2.16). Invasive procedures for removal of RPOC occurred in 12.2% of women in the study groups and in none of the women in the control group (p < .001). Conclusions: Manual placental removal harbors short- and long-term complications, including a high likelihood of RPOC necessitating further invasive procedures.

P23.01: Doppler colour scoring system using offline video analysis in women with an incomplete miscarriage: inter‐ and intraobserver reproducibility study

To assess inter- and intraobserver reproducibility of the Doppler colour scoring (DCS) system in women with 1st trimester incomplete miscarriage noted on transvaginal ultrasound (TVS). 32 digital videosets were recorded of women with incomplete miscarriage (presence of measurable focus of hyperechoeic material) on TVS. Vascularisation of retained products of conception (RPC) was recorded using DCS system of IOTA group: DCS 1=absence of vascularity, DCS 2=minimal vascularity, DCS 3=rather strong, DCS=4 very strong. CDS has been previously used to predict successful expectant management of incomplete miscarriage (Casikar et al. Hum Reprod 2013). Each videoset was then reviewed offline by 5 observers who apportioned a DCS to RPC. Same videos reanalysed, albeit in a different order, at least 7 days later, to assess intraobserver agreement. Inter- and intraobserver correlation was performed to determine agreement among the 5 observers. Interobserver agreement was also measured between each observer and reference standard (GC). Cohen's κ coefficient <0 suggests poor agreement, 0.01-0.20 slight, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 substantial, 0.81-0.99 almost perfect. Videoset sample size: assuming participants agree 60% of the time, a sample size of 31 is required with a relative error of 30%(Gwet, 2010). 61% and 89% of cases had agreement between >3 and >2 observers, respectively. Interobserver agreement ranged from moderate to substantial (0.48-0.751); agreement with GC ranged from moderate to substantial (0.495-0.678). 2 observers had almost perfect intraobserver agreement (0.905-0.912), 3 observers had substantial intraobserver agreement (0.653-0.691). Overall interobserver agreement for the CDS was substantial (0.626). CDS interobserver reproducibility between all observers and the reference standard ranged from moderate to substantial. CDS intraobserver reproducibility was substantial to almost perfect.