The Diagnostic Accuracy of Ultrasound in Retained Products of Conception in Postpartum Period by Using Histopathology as the Gold Standard

Saba  Sohail; Mohsin  Hussain; Ghazala  Shahzad; Abid Ali  Sahito; Sasui  Memon; Asma  Jatoi

doi:10.29054/apmc/2020.723

Saba Sohail Professor of Radiology, Dow University of Health Sciences Karachi Pakistan
Mohsin Hussain Senior Registrar, Radiology Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat Khairpur Pakistan
Ghazala Shahzad Assistant Professor, Radiology Liaquat University of Medical & Health Sciences, Jamshoro Pakistan
Abid Ali Sahito Assistant Professor, Radiology Bilawal Medical College, LUMHS, Jamshoro Pakistan
Sasui Memon Consultant Radiologist, Advance Diagnostic Center, BMC, LUMHS Jamshoro Pakistan
Asma Jatoi Senior Registrar, Radiology Bilawal Medical College, LUMHS, Jamshoro Pakistan

DOI: https://doi.org/10.29054/apmc/2020.723

Keywords: Diagnostic accuracy, Ultrasound, Retained products of conception in postpartum period, Histopathology

Abstract

Background: Retained product of conception (RPOC) has been the commonest factor involved in secondary post-partum hemorrhage. Ultrasound is a valuable diagnostic method for the diagnosis of PPH patients and is much more reliable than clinical presentation for the RPOC diagnosis alone. Objective: To determine the diagnostic accuracy of ultrasound in detection of retained products of conception in postpartum period in clinically suspected patients taking histopathology as gold standard. Study Design: Cross-sectional study. Settings: Radiology Department, Civil Hospital, Karachi Pakistan. Duration: From 5^th February 2017 to 4^th August 2017. Methodology: Total 135 patients with clinical suspicion of retained product of conception were included. Sonography was performed. D & C was performed and specimen sent for histopathology. The diagnostic accuracy of ultrasound was established regarding specificity, sensitivity, NPV, PPV, against histopathology. Post stratification chi square test was applied and p-value ≤0.05 was considered as significant. Results: The mean age of patients was 31.84±7.91 years. Mean duration of symptoms was 3.48±1.44 weeks. By ultrasound, 64.4% were diagnosed retained products of conception and by histopathology 54.8% were diagnosed. There were 65 true positive patients and 39 true negative patients. Specificity, Sensitivity, NPV, PPV, and accuracy were 63.9%, 87.8%, 81.2%, 74.7%, and 77% respectively. Conclusion: Ultrasonography was observed as a reliable diagnostic tool showed accuracy rate of 77.0% with 87.8% sensitivity and 63.9% specificity, in the diagnosis of retained products of conception (RPOC).