Endovaginal ultrasound (US) imaging and color Doppler flow imaging techniques were used to evaluate the uterus and its contents and to establish characteristics of a normal post-abortion appearance in 19 women who underwent elective first-trimester abortions. Twenty-two examinations were performed between 2 and 17 days after the procedure. Thirteen of the 22 examinations (59%) showed different amounts of intrauterine material of varying echogenicity. Seven of the 22 examinations (32%) showed a thick endometrial stripe, and only two showed a normal stripe. Color Doppler flow imaging demonstrated typical peritrophoblastic flow in four of eight patients on the second and third days after the abortions were performed. After the third day, flow was observed in only two of 11 patients, and intrauterine material was also seen. These results indicate that intrauterine material and low-impedance flow are frequently observed after an abortion and do not necessarily indicate clinically important retained products of conception.
PIP: Physicians performed endovaginal ultrasound imaging with pulsed and color Doppler flow imaging in 19 17-35 year old women within 7 days after they had undergone an elective first-trimester abortion (dilatation and curettage [D&C] suction) at the Yale University Hospital in Connecticut to determine the normal postabortion appearance of the uterus. They examined some of the women a 2nd time 14-17 days postabortion. At the end of 7 days, the uterus of 4 women still had a considerable amount of intrauterine material of varying echogenicity (=or2 cm anteroposterior dimension). The uterus of 7 other women had intrauterine material measuring 1.3-1.9 cm in size. 32% (7) of all examinations indicated a thick endometrial stripe. Just 2 examinations had a normal stripe. Typical peritrophoblastic flow, as revealed by color Doppler flow imaging, occurred in 4 of 8 (50%) patients on days 2 and 3 postabortion. Thereafter, color Doppler flow imaging detected this flow in just 2 of 11 (18.2%) patients. It also demonstrated intrauterine material. Human chorionic gonadotropin levels confirmed the ultrasound findings that no woman retained fetal parts or placentas. These clinical research findings have demonstrated that intrauterine materials and low-impedance flow are common following an abortion, but do not always signify a clinically significant amount of retained conceptus. Further, ultrasound imaging of women with symptoms suggestive of complications after an abortion may reduce the number of repeat D&Cs, thereby reducing the number of complications.