Coping with the emotional and physical aftermath of pregnancy-related experiences is no small feat. Women navigate a complex journey — hormonal shifts, baby blues, postnatal depression or the heart-wrenching loss of a miscarriage. While emotional recovery is crucial, paying attention to physical health is equally important. One important but often overlooked complication that can arise after pregnancy is Retained Products of Conception (RPOC).
What is RPOC?
RPOC refers to the fetal or placental tissue that remains in the uterus following a miscarriage, abortion, or childbirth. Dr M Rajini, consultant gynaecologist at CARE Hospitals in Banjara Hills, explains that the body usually removes the tissue naturally, but sometimes small pieces remain. “After childbirth, the placenta might not fully detach. Certain conditions, such as placenta accreta, where the placenta grows too deeply into the wall of your uterus, can also increase the risk of RPOC,” she adds.
Dangerous implications
If not promptly identified and treated, RPOC can lead to several complications that may impact reproductive health, such as heavy bleeding, which can result in anaemia. “Left untreated, RPOC can cause infections, leading to pelvic pain, fever, and, in severe cases, life-threatening sepsis. In rare cases, RPOC may lead to uterine scarring, known as Asherman’s syndrome, which can affect implantation and increase the risk of pregnancy complications,” says Dr Venkata Sujatha Vellanki, regional medical head and fertility specialist at Oasis Fertility.
Prevention and treatment
Dr Sujatha stresses the importance of proactive measures in reducing the risk of RPOC and its impact on fertility. “Ensuring the thorough removal of pregnancy tissue during procedures like dilation and curettage (D&C) minimises the risk of retained tissue. Careful monitoring through post-pregnancy ultrasounds, especially after a miscarriage or abortion, can help detect RPOC early before complications arise,” she notes.
Regarding diagnosis, Dr Rajini explains that in addition to using an ultrasound to detect retained tissue, a blood test measuring pregnancy hormone (beta-hCG) can also aid in diagnosis. “Early diagnosis and treatment with minimally invasive modalities like a hysteroscopy safeguard the endometrium and reproductive health. A hysteroscopy allows direct visualisation and removal of retained tissue, minimising damage and reducing the risk of scarring or adhesions,” both experts suggest.
Dr Rajini explains that there are signs to watch out for. "Heavy or prolonged bleeding, cramping and lower abdominal pain, and an enlarged uterus may indicate retained tissue. Foul-smelling vaginal discharge may indicate an infection, which can cause fever and chills," she says.
The gynaecologist points out that mild cases of RPOC may resolve on their own. “If not, medication such as misoprostol can help expel the tissue. Severe cases may require surgical intervention, such as dilation and curettage (D&C). In the presence of an infection, antibiotics are necessary,” she adds.
Though it may seem like a minor issue, RPOC plays a vital role in fertility. With proper care and timely diagnosis, women can recover fully and safeguard their reproductive health, paving the way for a healthier future.