Did you just have a baby? Or did you go through a traumatic experience like a miscarriage? After such an event, the body takes some time to recover. So, it is normal to have some vaginal bleeding and mild pain for a few days. However, if this bleeding is much heavier than normal, if you are passing large clots, or if there is no improvement after a few days, it is not a good idea to just give up. It may be due to a condition called "retained uterine tissue," which we are talking about today.
Simply put, what is retained part of the uterus (RPOC)?
This may sound a bit complicated when you hear the name, but it is very simple.
After the pregnancy period ends, that is, after a baby is born, after a miscarriage, or after an abortion, there are tissue parts left inside the uterus related to that pregnancy period, which is what we medically call `(Retained Products of Conception - RPOC)`. Think about it, during pregnancy, another important thing called the placenta develops in the uterus along with the baby, right? The baby gets the nutrition and oxygen it needs through this placenta. After the baby is born, this placenta should completely leave the uterus and come out. But sometimes, small pieces of this placenta, tissue parts of the embryo or fetus, or other tissue parts related to the pregnancy period may not be completely removed and remain stuck inside the uterus. That is why we call this condition.
So is this the same as "Retained Placenta"?
No, they are a little different. We call "Retained Placenta" when the entire placenta does not come out of the uterus within 30-60 minutes of delivery. In that case, we are talking about
the entire placenta . But `(RPOC)` is a slightly broader condition. Here, it is not the entire placenta, but
a small piece of placenta, a piece of fetal tissue, or anything else that may be left in the uterus. Simply put, `(Retained Placenta)` can be considered a type of `(RPOC)`.
What are the symptoms of this condition? How do you recognize it?
Because your body goes through so many changes after having a baby, it's sometimes easy to mistake these symptoms for something more normal. But it's important to be aware of this.
Remember, it's normal to bleed a little for a few weeks after having a baby or having a miscarriage. But it should gradually decrease. If it doesn't, it's something to pay attention to.
The main and most common symptom is
abnormal or excessive vaginal bleeding. Let's explain this further:
- Heavy bleeding : If you bleed enough to completely wet a pad every two hours.
- Passing large blood clots: If you pass blood clots that are larger than normal.
- Intermittent bleeding : If bleeding stops for a few days and then suddenly starts to bleed heavily again.
- Foul-smelling discharge: If vaginal discharge has a foul odor, it could be a sign of an infection.
In addition to this main symptom, several other symptoms can be seen.
| Symptom | Description |
|---|
| Fever and chills | If an infection occurs due to the remaining parts inside the uterus, a fever may occur. |
| Lower abdominal pain | It may feel like a sharp, constant pain or cramp in the lower abdomen. |
| Enlarged and sensitive uterus | During an examination, a doctor may find that the uterus is larger than expected and painful to touch. |
| Failure to resume monthly menstruation | If you are not breastfeeding, your period should usually start again within 6-8 weeks. If it doesn't, it could also be a sign of this condition. |
Why is this happening? Is there a specific reason for this?
It's often difficult to pinpoint a single cause. However, doctors have identified several factors that increase the risk of developing this condition.
The main risk factor is if you have had this condition (RPOC) in a previous pregnancy,The risk of this occurring again in subsequent pregnancies is high. In addition, the following conditions may also increase the risk.
| Risk factor | Simple explanation |
|---|
| Placenta Accreta | This is a condition where the placenta is directly attached to the uterine wall. Then, after the baby is born, it doesn't come off easily. There is a high chance that parts will remain. |
| Being over 35 years of age | The risk increases slightly if the mother is over 35 years old at the time of pregnancy. |
| Assisted Delivery | If you have to use instruments like forceps or vacuum to remove the baby. |
| Miscarriage or stillbirth during the second trimester of pregnancy (weeks 13-26) | During this time, there is a high chance that the placenta will not be completely removed and parts will remain. |
| Failure to Progress in Childbirth | As labor progresses, the uterus may become fatigued and not have the contractions necessary to completely expel the placenta. |
| Previous uterine surgery | If you have had previous cesarean sections (C-sections) or D&Cs, scar tissue in the uterus can cause the placenta to become deeply attached. |
| Having an irregularly shaped uterus | Some women's uteruses are slightly different in shape from birth, and even then, parts can remain. |
What will happen if these parts are not removed? Will there be serious problems?
Yes. If this condition is left untreated, it can sometimes lead to serious complications. That's why we say to be aware of these symptoms.
- Anemia : Excessive bleeding can cause a decrease in the amount of blood in the body, leading to symptoms such as fatigue and dizziness .
- Infections: The remaining tissue inside the uterus is a perfect place for bacteria to grow . This infection can spread to the fallopian tubes and ovaries , affecting your ability to have children in the future. Sometimes, this infection can spread throughout the body and cause life-threatening conditions like sepsis .
- Chronic Pelvic Pain: You may have lower abdominal pain for a long time.
- Asherman's Syndrome: This is a rare condition. An infection or treatment inside the uterus (especially a D&C) can cause the walls of the uterus to stick together. This can lead to irregular periods, miscarriages, and difficulty conceiving in the future.
How do doctors diagnose this condition?
It is difficult to be 100% certain that you have this condition based on symptoms alone. These symptoms can also be seen in other medical conditions. Therefore, your doctor may perform several tests to confirm this.
| Test method | What do you learn from that? |
|---|
| Transvaginal Ultrasound Scan | This scan, which involves inserting a small probe through the vagina, can clearly see if the inner wall of the uterus is thickened or if there are any lumps of tissue. |
| Color Doppler Ultrasound | This is also a type of scan. It can see if the remaining tissue in the uterus still has a blood supply. If there is a blood supply, it is most likely part of the placenta. |
| HCG blood test (Human Chorionic Gonadotropin Test) | HCG is a hormone produced by the placenta during pregnancy. If the level of this hormone in the blood is still high several weeks after the end of pregnancy, it indicates that parts of the placenta may still be present in the uterus. |
| Hysteroscopy | In this, a thin tube with a camera attached is passed through the vagina into the uterus and the inside is viewed directly on a screen. This allows you to see exactly what parts are left. |
What are the treatments for this?
If this condition is confirmed, the remaining parts need to be removed. There are two main treatment options for this. Your doctor will determine the most appropriate treatment for you based on your condition, the severity of your symptoms, and the amount of tissue remaining. 1.
Medical Management:- Misoprostol: This is a medicine that is taken as a pill or placed in the vagina. It causes the uterus to contract (dilate). When the uterus contracts, it pushes out the remaining contents.
2.
Surgical Management:- Dilation and Curettage (D&C): This is a minor surgery. In Sinhala, we also call it "washing out the uterus." Here, the cervix is opened slightly, a special instrument (often a suction tube) is inserted, and any remaining debris stuck to the walls of the uterus is cleaned and removed. This is usually done under anesthesia.
Are there any risks with these treatments?
As with any medical procedure, there are very small risks with these procedures. Things like heavy bleeding and infection can happen with both, but the chances are very low. D&C is very rare.
A uterine perforation can occur, but it often heals on its own. The most important thing is to talk openly with your doctor about these treatments and their pros and cons. Then you can make an informed decision.
What emergencies require seeing a doctor?
After the end of your pregnancy, if you have any of the following symptoms, go to a hospital's Emergency Department (ETU) immediately or inform your doctor.- Difficulty breathing
- Very heavy vaginal bleeding (wetting more than one pad per hour)
- High fever
- Nausea and vomiting
- Unbearable, severe lower abdominal pain
In such a situation, do not wait at home. The safest thing to do is to seek medical advice immediately. I know that facing such a situation can be very difficult, even mentally. When you want to experience the joy of having a baby, or when you are trying to get rid of the pain of a miscarriage, it is normal to feel a great burden when you are told that you will have to undergo another treatment. But remember, this is a condition that can be completely cured with treatment. Many women are able to get pregnant again without any problems after this treatment and have healthy children. Talk openly with your doctor, your husband, and your family about your questions, fears, and feelings. It will be a great relief for you. Take-Home Message
- The presence of remnants of uterine tissue after the end of pregnancy (childbirth, abortion) is called residual uterine tissue (RPOC) .
- The main symptoms are heavy bleeding, fever, and lower abdominal pain .
- If bleeding does not gradually decrease after childbirth or an abortion, but increases or starts again, see a doctor immediately.
- If this condition is left untreated, it can lead to anemia and serious infections.
- This can be detected through ultrasound scans and blood tests, and can be completely cured with medication or a minor surgery (D&C).
- After receiving proper treatment, there is usually no impact on healthy pregnancies in the future.
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