Comparitive Efficacy of Transabdominal and Transvaginal Sonography Augmented With Color Doppler and Biomarkers in Diagnosis of Retained Products of Conception
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Abstract
Background: Retained products of conception are an important cause of abnormal post-pregnancy bleeding and may lead to infection, hemorrhage, intrauterine adhesions, and future reproductive complications if not accurately diagnosed. Ultrasonography is the main imaging modality for evaluation, but the relative diagnostic performance of transabdominal sonography and transvaginal sonography may differ, particularly when supplemented by color Doppler and serum β-hCG. Objective: To compare the diagnostic performance of transabdominal and transvaginal sonography, with adjunctive color Doppler and serum β-hCG assessment, in women clinically suspected of having retained products of conception. Methods: This prospective comparative cross-sectional diagnostic accuracy study included 116 women aged 18–45 years with clinical suspicion of retained products of conception after miscarriage, abortion, termination, or pregnancy-related uterine intervention. All participants underwent TAS followed by TVS with color Doppler assessment, and serum β-hCG was measured using quantitative immunoassay. Imaging impressions were compared with the final diagnostic classification. Results: Final RPOC positivity was 44.8% (52/116). TAS identified suspected RPOC in 22.4% of participants, whereas TVS identified suspected RPOC in 44.8%. Against the final diagnostic classification, TAS showed sensitivity of 50.0%, specificity of 100.0%, positive predictive value of 100.0%, negative predictive value of 71.1%, and overall accuracy of 77.6%. TVS showed complete agreement with the final diagnostic classification in the supplied dataset, although this should be interpreted cautiously if TVS contributed to final diagnosis. Mean serum β-hCG was higher in RPOC-positive cases than RPOC-negative cases (2128.88 ± 922.53 IU/L vs 121.95 ± 73.76 IU/L; p < 0.001). Conclusion: TVS identified more suspected RPOC cases than TAS and showed stronger agreement with final diagnostic classification. Serum β-hCG and color Doppler vascularity provided useful adjunctive diagnostic information. A multimodal approach using clinical assessment, TVS, Doppler, and β-hCG may improve diagnostic confidence in suspected RPOC
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