QuestionI 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.
AnswerSS
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
