Current approaches to the diagnosis and management of retained products of conception and enhanced myometrial vascularity of the first trimester

Introduction:Aim of this narrative review is to provide an update on diagnosis, management and outcome of RPOC and EMV diagnosed after first trimester pregnancy. Retained products of conception (RPOC) and enhanced myometrial vascularity (EMV) are considered complications following pregnancy and there is scarce agreement upon their management.Methods:A comprehensive, narrative, research was conducted. A literature review of relevant studies published between 2000 and 2025 was carried out using MEDLINE and the Cochrane library using the following terms: ‘Arteriovenous Malformations’[Mesh] OR ‘Uterine Haemorrhage’[Mesh] OR ‘enhanced myometrial vascularity’[tiab] AND ‘Abortion, Incomplete’[Mesh] OR ‘Abortion, Induced’[Mesh] OR ‘Abortion, Spontaneous’[Mesh] OR ‘retained product* of conception’[tiab]. Priority was given to randomised controlled trials, systematic reviews and meta-analyses and validating cohort studies.Results:This review was eventually based on the evidence of 208 articles.Discussion:According to current literature data, RPOC and EMV are common findings after first trimester termination of pregnancy or miscarriage. Both entities have excellent outcome, low complications rate and good fertility outcome following resolution after expectant, medical and surgical management. No significant differences appear by choice of management, however expectant approach may be recommended due to worldwide feasibility, low cost and avoidance of operative risks. Conservative management deals with the patient’s commitment to be followed for several weeks necessary for the complete resorption of RPOC and/or EMV.SHORT CONDENSATION With this review we aim to provide up-to-date and evidence based guidance to physicians managing first trimester RPOC and EMV. This two conditions are frequently encountered in routine gynecological care, yet often misdiagnosed and treated inconsistently.