RETAINED PRODUCTS OF CONCEPTION

Manejo Conservador de Retención de Productos de la Concepción con Anticonceptivos Orales Combinados. Presentación de Caso CONSERVATIVE MANAGEMENT WITH COMBINED ORAL CONTRACEPTIVES. CASE DEPICTION

SUMMARY

Objective: to show the case of a patient with retained products of conception (RPC) after a medical abortion, succesfully treated with combined oral contraceptives (COC), and review the literature. Clinical Case: A 37-year-old woman, with scant bleeding and mild pelvic pain, who had a misoprostol induced medical abortion three days before, at admission she had no signs of infection and a 19 mm mixed endometrial finding. In clinical and ultrasound monitoring during six weeks, mixed endometrium persists, with slow decrease in human chorionic gonadotrophin (HCG), and RPC is suspected, so that a COC cycle is supplied and when finished she has complete expulsion of retained tissue. Two months later hysteroscopy is normal. Discussion: RPC occurs after childbirth or abortion, diagnostic criteria are: persistent bleeding, ultrasound findings and HCG measurement; the differential diagnosis includes gestational trophoblastic disease and uterine arteriovenous malformations. Conservative management is feasible with low rates of infection or surgical procedures, however, given prolonged evolution, the presence of signs of infection or significant bleeding, surgical evacuation is mandatory, traditionally with dilation and curettage, and more recently, hysteroscopic resection. In our case, the patient took a COC cycle and at the end she expeled the retained remains. Conclusions: the conservative management of CPR with COC arises as an option in selected cases, controlled studies are necessary to define its usefulness.

Keywords: misoprostol, incomplete abortion, combined oral contraceptives.