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Hum. Reprod. Advance Access published online on January 13, 2005
Human Reproduction, doi:10.1093/humrep/deh689
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Human Reproduction © European Society of Human Reproduction and Embryology 2005; all rights reserved
Received June 7, 2004
Revised September 13, 2004
Accepted November 25, 2004

Article

Sonographic versus clinical evaluation as predictors of residual trophoblastic tissue

Ido Ben-Ami 1*, David Schneider 1, Ron Maymon 1, Zvika Vaknin 1, Arie Herman 1, and Reuvit Halperin 1

1 Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin (affiliated with Sackler School of Medicine, Tel-Aviv University, Tel-Aviv), Israel

* To whom correspondence should be addressed.
Ido Ben-Ami, E-mail: idorit{at}netvision.net.il


  Abstract

BACKGROUND: The study aims to compare the diagnostic accuracy of sonographic evaluation versus clinical estimation in women suspected to have retained trophoblastic fragments. METHODS: The study group consisted of 68 consecutive patients admitted to our department due to suspected residual trophoblastic tissue. Each woman underwent ultrasound and physical examination by expert clinicians. The clinicians performing the physical examination were not informed of the sonographic findings, and vice versa. RESULTS: Patients were divided into three subgroups: clinical suspicion only of residual trophoblastic tissue (n=8), sonographic suspicion only (n=44) and combined sonographic and clinical suspicion of residual trophoblastic tissue (n=16). In the latter group, in 14 out of 16 women (87.5%) retained trophoblastic tissue was confirmed by histological examination, a significantly higher rate compared to ultrasonographic (45.5%, P<0.002) or clinical suspicion only (62.5%, P=0.07). The specificity and positive predictive value of the clinical examination were significantly higher compared to ultrasonographic evaluation (P<0.05), while the sensitivity of the ultrasonographic evaluation was higher than the clinical estimation (P<0.05). There was no statistically significant difference in the negative predictive value or in diagnostic accuracy between the two methods. CONCLUSIONS: Based on our current experience, it seems that the combination of both clinical and ultrasonographic evaluation is recommended before uterine curettage is performed, thus lowering the rate of unnecessary invasive procedures.

Keywords: clinical estimation; diagnostic accuracy; residual trophoblastic tissue; sensitivity and specificity; transvaginal sonography.
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