Sonographic findings after induced medical abortion at 12-21 weeks of gestation: Retrospective cohort study

Abstract

Objective: To evaluate sonographic findings and clinical outcomes after induced medical abortions.

Study design: We reviewed records of women who had induced medical abortions at 12-21 weeks of gestation at the Osaka University Hospital between January 2010 and May 2018. Clinicians evaluated each patient using two-dimensional grayscale transvaginal ultrasonography approximately 1 day, 1 week and 1 month after abortion as a routine care in our hospital. Clinicians employed color Doppler imaging if they detected hyperechoic mass within the endometrial cavity. We evaluated the endometrial vascularity as follows: grade 1, minimal flow; grade 2, moderate flow; and grade 3, highly vascular. We evaluated the incidence of vascularity and assessed the clinical course according to the quantity of vascularity. Clinicians did not provide intervention based on ultrasound findings alone.

Results: Of 319 patients, 75 (24%) had vascularity at one or more evaluations, including 1% (3/319), 12% (38/319) and 15% (48/319) at 1 day, 1 week and 1 month after abortion, respectively. Of these, 44 had grade 1, 16 had grade 2, and 15 had grade 3. Fifty-four women (72%) with a vascularity had no symptoms. All sonographically-identified vascularity resolved spontaneously regardless of symptoms and quantity of vascularity within 150 days (mean interval 68.6 ± 32.2 days). No patients required transfusion or invasive procedures.

Conclusions: Vascular endometrial findings were prevalent after induced medical abortions; however, most were asymptomatic, appeared an average of approximately 3 weeks after abortion, and all resolved spontaneously.

Implications: Although hypervascularity can be found routinely on ultrasonography after induced medical abortions, this finding commonly resolves spontaneously regardless of symptoms and its quantity. Thus, hemodynamically stable patients, even those with sonographic hypervascularity, can be managed expectantly.

Keywords: Abortion; Enhanced myometrial vascularity; Placental polyp; Pregnancy outcome; Retained products of conception.