Transvaginal color doppler ultra-sonography in bleeding patients suspected of having residual trophoblastic tissue

ABSTRACT

Residual trophoblastic tissue is an infrequent sequel to labor and abortion presenting as late postpartum and postabortion hemorrhage. Because it may be difficult to make an accurate diagnosis on clinical grounds alone, ultrasound is often used as a non invasive diagnostic method. The aim of this study was to evaluate the diagnostic accuracy and clinical usefulness of transvaginal color doppler ultrasonography [TV-CDU] in postpartum and postabortion patients with excessive hemorrhage who are suspected of having residual trophoblast. Forty-six women with excessive hemorrhage referred for possible residual trophoblastic tissue were evaluated by [TV-CDU]. Based on color doppler imaging [GDI], patients were divided prospectively into groups Women who had an empty uterus with a normal uterine cavity, those with a pure endometrial fluid collection and no echogenic foci of echogenicity, and those with intracavitary heterogeneous material with mixed echo patterns of fluid and solid components. In each group, doppler studies were performed and the resistance index [RI] was calculated. The doppler results were correlated with clinical and pathologic follow-up Twenty- six subjects had a normal uterine cavity and seven had a pure endometrial fluid collection, all were treated conservatively and none showed later clinical evidence of residual trophoblastic tissue. In thirteen women, residual trophoblast was strongly suggested from the [GDI] of ultrasonography Five showed an endometrial fluid collection with some echogenic foci, and eight exhibited intracavitary mixed echogenic material. All underwent curettage, and residual trophoblastic tissue was found in ten of the thirteen. The mean [ +/- standard deviation] RI to flow in the myometrial arteries was 0.54 +/- 0.15 in women without residual traphoblast and 0.35 +/- 0.1 in those with residual trophoblastic tissue [P<0.01]. Our experience suggests that [TV-CDU] is an effective noninvasive method for evaluating patients with postpartum and postabortion hemorrhage who are suspected of having residual trophoblastic tissue. Its use enhances the-positive preoperative diagnosis of residual trophoblastic tissue and may reduce unnecessary curettage procedures