TRANSVAGINAL ULTRASONOGRAPHY COMBINED WITH COLOR VELOCITY IMAGING ANDPULSED DOPPLER TO DETECT RESIDUAL TROPHOBLASTIC TISSUE

The value of transvaginal B-mode ultrasonography combined with color v elocity imaging and pulsed Doppler to detect retained trophoblastic ti ssue was evaluated prospectively in a series of 40 patients with postp artum (n = 15) or postabortion (n = 25) bleeding. Color velocity imagi ng was wed to identify color-coded blood flow signals within myometriu m and/or endometrium. Flow was subjectively quantified as absent, scan ty or abundant. Pulsed Doppler was used to assess blood flow impedance by calculating the resistance index. The presence of abundant flow wi th a lowest resistance inner of less than 0.45 was considered as suspi cious of residual trophoblastic tissue. Twenty-two (55%) out of the 40 patients underwent dilatation and curettage and chorionic villi were demonstrated in 15 of these. Eighteen (45%) patients were managed cons ervatively. None of these patients suffered complications or needed re admission for currettage, and all of them were considered as not havin g retained tissue. On color pulsed Doppler ultrasound examination, 15 patients had suspected retained tissue; all of these underwent curetta ge and residual trophoblast was found in 14 (93.3%). Out of 25 patient s considered as having no residual tissue on color pulsed Doppler ultr asound examination, seven underwent curettage and chorionic villi were found in one patient (false-negative rate 6.7%) All patients managed conservatively had an unsuspicious scan. We concluded that transvagina l ultrasonography combined with color velocity imaging and pulsed Dopp ler could be useful to detect retained trophoblastic tissue and to sel ect patients suitable for conservative management.