ObGyn/Pregnancy issues/RPOC after D&C


I had a miscarriage & DnC at 9 wks gestation.  Embryo was triploidy.  
-3 wks post-op I had new, heavy, bright red bleeding, HCG was just under 4000. By 4 wks HCG was 3300.  
-5 wks post-op & still bleeding, I had an ER scan showing retained tissue.  I was told I'd need another DnC to remove it.  The OB dismissed it because the HCG continued to slowly decrease (was 2065 at ER).  
-A second opinion at 6 weeks post-op from a specialist found the retained tissue (1.8 cm) with a sonohysterogram, Dr recommended operative hysteroscopy.  HCG was now 900.  
-At 7.5 wks post-op, new Dr performed hysteroscopy to remove the tissue.  3 days later, my HCG no longer registers on an at-home pregnancy test.

My question- is it normal standard of care to use "expectant management" with known retained placenta after a DnC and 6+ wks have passed?  If yes, how long is it safe to continue to "watch and wait?"  This OB was prepared to wait 2-3 more mos despite knowing my age (almost 38) & desire to conceive again.


There is no place for a"wait and see policy" once a diagnosis of retained tissues is made. This should be removed and at the current state of knowledge, a diagnostic hysteroscopy and removal of the tissue is the gold standard. At 4 weeks post D & c, the level of hCG should be zero. There is no evience in the literature to wait for 2-3 months after the curettage expecting that the level will reach zero without intervention if the diagnosis of retained tissue is made.

Good Luck

ObGyn/Pregnancy issues

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Mohamed Kandeel


I can answer questions about antenatal care, medical problems associated with pregnancy, labor and delivery and postpartum care.


Currently I am working as a Professor of Obstetrics gynecology, Menofyia University, Egypt. Since 1987, I worked in many university and private hospitals with a high load of pregnant population averaging 7-9,000 deliveries/year. This exposed me to all problems associated with pregnancy, labor and delivery. I had my doctorate degree in Obstetrics and Gynecology in 1996 in the use of Doppler ultrasound in high risk pregnancies.

Menofyia University, Egypt

-British Journal of Obstetrics and Gynecology (Kandil M) -Egyptian Journal of Obstetrics and Gynecology (Kandil M) -Ain Shams Journal of Medicine (Kandil M)

-Master's degree in obstetrics and Gynecology 1989 -Doctorate degree in Obstetrics and Gynecology 1996

Awards and Honors
Editorial advisor: Fetal monitoring section of the international website www.obgyn.net

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