Case Report

Unusual Manifestation of Retained Product of Conception in the Cervix: A Case Study

Abstract

Retained products of conception (RPOC) occur when fragments of the placenta or decidual tissue remain in the uterus, often leading to postpartum hemorrhage. Early and accurate diagnosis, aided by ultrasonography, is essential for appropriate management and prevention of complications. We report a case of a 22-year-old woman admitted to our tertiary medical department with irregular vaginal bleeding and abdominal pain. She had no significant past medical history. Abdominal ultrasonography revealed a normal-sized uterus with homogeneous myometrial echogenicity. However, a heterogeneous echogenic mass, exhibiting considerable vascularity and feeding vessels from the endometrial cavity, was observed in the cervix. Additionally, the patient’s beta human chorionic gonadotropin (Beta-HCG) concentration was positive, with a titer of 201 µ/l, despite her claim of being a virgin. Subsequently, the patient underwent hysteroscopy, during which an infected and malodorous lesion was removed from the uterus, confirming the diagnosis of RPOC. In follow-up assessments, she experienced no complications. To the best of our knowledge, no cases of RPOC located in the cervix have been reported previously, as RPOC is typically expected to be found in the endometrial cavity. This study aims to share our experience in considering the differential diagnosis of RPOC as cervical lesions and highlights the importance of ultrasonography in early pregnancy management.

[1] Koethe Y, Rizzuto GA, Kohi MP, editors. Retained Placenta Accreta Presenting as Secondary Postpartum Hemorrhage. 2015. https://doi.org/10.23937/2377-9004/1410035
[2] Belfort MA. Placenta accreta. Am J Obstet Gynecol. 2010;203(5):430-9. https://doi.org/10.1016/j.ajog.2010.09.013
[3] Fujishima R, Kawasaki K, Moriuchi K, Shiro R, Yo Y, Matsumura N. Conservative Management for Retained Products of Conception in Late Pregnancy. Healthcare (Basel). 2023;11(2):168. https://doi.org/10.3390/healthcare11020168
[4] Adkins K, Minardi J, Setzer E, Williams D. Retained Products of Conception: An Atypical Presentation Diagnosed Immediately with Bedside Emergency Ultrasound. Case Rep Emerg Med. 2016;2016:9124967. https://doi.org/10.1155/2016/9124967
[5] Sellmyer MA, Desser TS, Maturen KE, Jeffrey RB Jr, Kamaya A. Physiologic, histologic, and imaging features of retained products of conception. Radiographics. 2013;33(3):781-96. https://doi.org/10.1148/rg.333125177
[6] Han L, Shi G, Zheng A, Ruan J. Hysteroscopy for retained products of conception: a single-institution experience. BMC Womens Health. 2023;23(1):25. https://doi.org/10.1186/ s12905-023-02170-0
[7] Foreste V, Gallo A, Manzi A, Riccardi C, Carugno J, Sardo ADS. Hysteroscopy and Retained Products of Conception:
An Update. Gynecol Minim Invasive Ther. 2021;10(4):203-9. https://doi.org/10.4103/GMIT.GMIT_125_20
[8] Kobayashi M, Nakagawa S, Kawanishi Y, Masuda T, Maenaka T, Toda A, et al. The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or postpartum women: a retrospective case control study. BMC Pregnancy Childbirth. 2021;21(1):653. https://doi.
org/10.1186/s12884-021-04083-y
[9] Hamerlynck TWO, Meyers D, Van der Veken H, Bosteels J, Weyers S. Fertility outcome after treatment of retained
products of conception: a systematic review. Gynecol Surg. 2018;15(1):12. https://doi.org/10.1186/s10397-018-1044-6
[10] Ustunyurt E, Kaymak O, Iskender C, Ustunyurt OB, Celik C, Danisman N. Role of transvaginal sonography in the diagnosis of retained products of conception. Arch Gynecol Obstet. 2008;277(2):151-4. https://doi.org/10.1007/s00404-
007-0436-z
[11] Kamaya A, Petrovitch I, Chen B, Frederick CE, Jeffrey RB. Retained products of conception: spectrum of color Doppler findings. J Ultrasound Med. 2009;28(8):1031-41. https://doi. org/10.7863/jum.2009.28.8.1031
[12] Sadan O, Golan A, Girtler O, Lurie S, Debby A, Sagiv R, et al. Role of sonography in the diagnosis of retained products of conception. J Ultrasound Med. 2004;23(3):371-4. https://doi. org/10.7863/jum.2004.23.3.371
[13] Sellmyer MA, Desser TS, Maturen KE, Jeffrey RB Jr, Kamaya A. Physiologic, Histologic, and Imaging Features of Retained Products of Conception. Radiographics. 2013;33(3):781-96. https://doi.org/10.1148/rg.333125177
Files
IssueVol 9 No 3 (2024): May-June QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/crcp.v9i3.17231
Keywords
Retained product of conception (RPOC) Cervical polyp Cervical lesions Gynecology

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How to Cite
1.
Livani S, Fatemi A, Jahanshahi M. Unusual Manifestation of Retained Product of Conception in the Cervix: A Case Study. CRCP. 2024;9(3):88-92.