Routine US for RPOC After 2nd Trimester Loss?

Today, we’re stepping into one of the most clinicallydelicate and emotionally heavy scenarios you can encounter in women's healthcare: a mid-pregnancy loss, say right around that 18 to 20-week mark. It’s a situation where the clinical room feels still, the emotional weight is immense, and every decision you make as a clinician carries profound gravity. Picture the scenario: The delivery has occurred. Both the fetus and the placenta have delivered, and upon gross visual examination on the delivery tray, the placenta appears intact. The immediate crisis of delivery has passed. But as theattending provider, you’re now standing at a critical management fork in the road. Do you routinely order an ultrasound before discharge to confirm the uterine cavity is truly clear? Or do you take a selective, symptom-driven approach, reserving uterine US imaging for patients who present with post-delivery warning signs like unexpected hemorrhage, severe pain, or fever? It sounds like a straightforward question, but in practice, it sparks intensedebate. Listen in, as we review professional society guidelines and the latest published data.

1.     Fox CE, et al. Mid‐trimester Pregnancy Loss GuidelineConsensus Panel. Triage and care for women with symptoms or diagnosis of pregnancy loss between 14 + 0 and 21 + 6 weeks' gestation. Int J Gynaecol Obstet. 2026 Jan;172(1):25-50. doi: 10.1002/ijgo.70621.

2.     Incognito GG, et al. Ultrasound Assessment ofRetained Products of Conception (RPOC): Insights from the Current Literature. J Clin Med. 2025 Aug 19;14(16):5864. doi: 10.3390/jcm14165864.

3.     ACOG PB 135: Second Trimester Abortion

4.     Sundararajan S, Roy S, Polanski LT. The accuracyof ultrasound scan in diagnosing retained products of conception: a systematicreview and meta-analysis. Am J Obstet Gynecol. 2024 May;230(5):512-531.e3.