Complete work-up for the management of retained products of conception

Retained products of conception represent an uncommon complication after miscarriage, planned termination of pregnancy, term spontaneous vaginal delivery or caesarean section. The aim of this study was to review the diagnostic and therapeutic management of this condition, according to the current literature, in order to assess patients correctly and reduce the number of unnecessary procedures with all their consequences. This updated review of the literature explores the pathophysiology, clinical features, diagnostic investigations, and treatment options for this complex condition. Laboratory tests are normal in most cases and have limited utility. Gray scale and Color Doppler ultrasound are the first line modality for the diagnosis of RPOC, even if ultrasound features alone should not be considered as conclusive, having an overall reported sensitivity of 44-85% and a specificity of 88-94%. Hysteroscopic resection of placental remnants, in absence of electricity use, seems to be the best treatment option with low risks and less complications related to fertility. Diagnosis and correct management of RPOC remain a major clinical challenge, since no clearly defined diagnostic criteria and treatment guidelines still exist. Hysteroscopic resection seems to be a good option, but well-designed randomized controlled trials are needed to define the best treatment modality.