Design: Retrospective cohort study

Setting: Single tertiary level unit

Patients or Participants: 1324 records of patients between January 2017 - December 2023 were reviewed. Ultrasound based volume of RPOC and doppler scores of vascularity were noted. 83 patients who chose misoprostol for management of RPOC were included in the study. Medical management was deemed to be successful if a follow-up ultrasound showed an empty uterus and unsuccessful if there was presence of persistent RPOC, requiring surgical management.

Interventions: N/A

Measurements and Main Results: The mean age of participants include din the study was 30.9 years. The baseline characteristics were comparable. The mean gestational age at the time of the antecedent event was 7.6 weeks. The mean duration of persistent bleeding was 12.1 days (+/- 9.4). The mean volume was 6.39ml. 24.09% ( 20/83) had a power doppler colour score ( PDCS) of 1 showing no vascularity, 39.7% ( 33/83) had a PDCS of 2 showing minimal vascularity, 24.09% ( 20/83) had a PDCS of 3 showing moderate vascularity and 12.04% had a PDCS of 4 showing high vascularity. The overall rate of successful management was 73.4% but using independent samples T-test, the outcome variable of successful management between the various PDCS scores and volume was not found to be statistically significant (p 0.081 and p 0.159 respectively).

Conclusion: This study concludes that irrespective of the antecedent event in first trimester, the volume of RPOC or the vascularity scores, medical management with misoprostol has a high rate of success in managing RPOC hence avoiding surgical intervention.