DIAGNOSTIC AND THERAPEUTIC DECISION-MAKING WITH TRANSVAGINAL SONOGRAPHY FOR FIRST-TRIMESTER SPONTANEOUS-ABORTION, CLINICALLY THOUGHT TO BE INCOMPLETE OR COMPLETE

The purpose of this study was to evaluate the diagnostic accuracy of t ransvaginal sonography for first trimester spontaneous abortions, thou ght to be incomplete or complete, in patients with postabortion bleedi ng or uterine cramping within 5 days of abortion. In a prospective stu dy, 78 patients underwent transvaginal sonography to evaluate the maxi mum anteroposterior diameter of the uterine cavity on the long axis vi ew and echo pattern of the retained products of conception. Patients w ere divided into three groups: those with a normal uterine cavity or a uterine cavity with fluid collection without echogenic foci (n = 13, group A), those with a uterine cavity containing fluid mixed with soli d components (n = 38, group B), and those with a uterine cavity contai ning solid components (n = 27, group C). Group A was considered not to have retained products of conception, and the latter two groups were considered to have retained products of conception. Patients in group A were assigned to receive conservative treatment. In groups B and C, patients with significant vaginal bleeding during 48 h of follow-up un derwent effective curettage and those with minimal-mild bleeding recei ved conservative management. A total of 73 patients (12 in group A, 35 in group B, and 26 in group C) completed the study. There were no dif ferences in any of selected reproductive data of the groups (p >0. 05) . In group B, all patients with uterine cavity diameter of 10 mm or gr eater underwent elective curettage. In group C, all patients with a di ameter of the uterine cavity 8 mm or greater underwent elective curett age. The overall complication and patient satisfaction rates were appr oximately 14% and 88%, respectively. Transvaginal sonographic findings can be used as a decision factor in the management of patients with f irst trimester spontaneous abortion to reduce the need for an elective curettage by approximately 58%. CONTRACEPTION 1998;57:393-397 (C) 199 8 Elsevier Science Inc. All rights reserved.