Persistent abnormal uterine bleeding in a reproductive-age woman: A case of misleading tests and RPOC

• Author Details:   
• Shilpa Kshirsagar
• Prachi Dwivedi ^*

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Abnormal uterine bleeding (AUB) is a common gynecological issue with multiple etiologies, including retained products of conception (RPOC). RPOC often presents diagnostic challenges as its features can resemble other conditions, such as gestational trophoblastic disease (GTD) or arteriovenous malformations (AVM). Timely diagnosis and appropriate management are crucial to prevent long-term complications, including infertility. This case report emphasizes as how keeping clinical suspicion high helped effectively managing AUB caused by RPOC. A 34-year-old woman, gravida 1, para 1, presented with persistent vaginal bleeding for 20 days. The patient had a known history of PCOS but no history of recent pregnancy, missed periods, or use of abortifacients. Initial evaluation at an outside clinic, including urine pregnancy test and beta-hCG levels, ruled out pregnancy. Transvaginal ultrasound revealed normal uterine and adnexal structures, and the patient was started on Dienogest for presumed abnormal uterine bleeding. Despite 13 days of hormonal therapy, the bleeding persisted, prompting further evaluation. Physical examination and additional investigations showed no abnormalities, and hysteroscopy revealed hyperplastic endometrium. Dilation and evacuation (D&E) were performed, and histopathology confirmed retained products of conception (RPOC). The patient responded well post-procedure, with resolution of symptom. This case underscores the need for a comprehensive diagnostic approach with high clinical suspicion in AUB, particularly considering RPOC as a potential cause. Hysteroscopy serves as a valuable tool for both diagnosis and treatment, but in misleading cases clinical suspicion always helps to reach to the diagnosis.