New research aims for better care after pregnancy loss complications
Researchers at Nepean Hospital are investigating safer, more consistent ways to manage a relatively common complication after early pregnancy loss or termination.
Retained products of conception (RPOC) is a potentially dangerous condition where tissue remains in a woman’s uterus after pregnancy, most commonly after miscarriage or termination, and is often managed through surgery.
The Ultrasound for Retained Products of Conception (U-RoC) trial is led by Dr Caroline Mathias and supervised by Professor George Condous, along with the team at Nepean Hospital’s Early Pregnancy Assessment Service.
The research aims to demonstrate how two specific approaches to managing RPOC could prevent unnecessary surgical interventions for women, helping to minimise associated risks.
“We know that surgery works, but it comes with its problems,” explains Dr Mathias.
“Every time we intervene in a uterus that has recently been pregnant, there’s risk of intrauterine adhesions; areas of scar tissue that can affect fertility in the future.”
Dr Caroline Mathias
In response to this problem, the trial will use ultrasound to compare the use of two low intervention options for RPOC: a conservative watch-and-wait approach, and a drug called misoprostol, which speeds up the process of passing pregnancy tissue naturally.
“We are comparing two non-operative techniques and trying to see if ultrasound can predict how successful they will be,” outlines Dr Mathias.
The role of ultrasound is a key feature of the study, determining vascularity scores that indicate how much blood is going to the affected tissue.
“Our hypothesis is that for certain vascularity scores, non-operative management will work very well,” explains Dr Mathias.
“Our trial should offer scientific reassurance that simply watching and waiting or giving misoprostol is effective, avoiding the risk of surgery and intrauterine adhesions.”
Dr Caroline Mathias
Dr Mathias also explains that, aside from the risks of surgery, performing it for some patients unnecessarily is not the most cost-effective model.
“Surgery that’s not required isn’t good for the patient, but it’s not great for the hospital either,” says Dr Mathias.
Part of the current problem for managing RPOC most effectively is a lack of research-based guidelines.
“There are currently no unifying national or international guidelines,” says Dr Mathias, explaining that this can leave both clinicians and patients uncertain about symptoms and management options.
“Currently, we lack the science to tell women what is normal or abnormal, including how long the condition may last, how best to intervene, and the expected severity of symptoms like spotting and pain,” says Dr Mathias.
By contributing to a better understanding of RPOC, the research will also improve diagnostic accuracy, helping clinicians to give their patients clearer information about the condition, including symptoms and recovery.
The project was awarded a Trainee Research Grant, funded by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ (RANZCOG) Women’s Health Foundation following a highly competitive selection process.
The trial commenced at Nepean Hospital in 2025 and is expected to run until 2027.
Findings from the U-RoC trial are expected to strengthen the evidence base for managing retained products of conception (RPOC) and contribute to more consistent, patient-centred care locally and beyond.