Retained Products of Conception (RPOC) Imaging

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Miscarriage/postpartum bleeding · cavity findings
   Miscarriage/postpartum bleeding — intracavitary findings? (RPOC = retained fetal/placental tissue after miscarriage/delivery/termination, a major cause of secondary postpartum/post-miscarriage bleeding. US (TVUS + Doppler): an intracavitary echogenic mass is the most sensitive and specific sign; endometrial thickness ≥15 mm (thresholds vary); RPOC has sparse vascularity. DDx: clot (no flow), EMV/AVM (flow in the myometrium), placental polyp, GTD.)
   • Intracavitary echogenic mass ± minimal flow (suspect RPOC) → Suspect RPOC · assess curettage risk
   • Predominantly honeycomb high-velocity myometrial flow (suspect EMV/AVM) → Suspect EMV/AVM · no curettage
   • Only blood/clot, no mass and no flow → Clot only · expectant follow-up
2. [End] Clot only · expectant follow-up
   Intracavitary blood/clot only (no echogenic mass, no flow): usually expectant/follow-up; correlate with beta-hCG and bleeding amount; repeat ultrasound if abnormality persists.
3. [End] Suspect EMV/AVM · no curettage
   Predominantly honeycomb high-velocity turbulent myometrial flow (suspect enhanced myometrial vascularity/AVM): no blind curettage (massive bleeding risk); move to the AVM/EMV pathway — stratify by PSV (low PSV expectant, high PSV/active bleeding → uterine artery embolization).
4. [End] Suspect RPOC · assess curettage risk
   Intracavitary echogenic mass (suspect RPOC): correlate with beta-hCG, bleeding amount and Doppler (Gutenberg score stratifies bleeding risk); management — expectant/medical or curettage (beware bleeding with rich vascularity, UAE pretreatment if needed); differentiate from EMV/AVM and GTD.

Source guidelines & references

• RPOC ultrasound assessment and EMV differentiation (UOG 2018; J Clin Med 2025)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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