Advantages of contrast-enhanced ultrasonography and uterine balloon tamponade during intrauterine evacuation of retained products of conception

Aim: Retained products of conception (RPOC) can cause postpartum hemorrhage. However, if intrauterine evacuation is performed for RPOC without adhesion, it can lead to massive hemorrhage due to an inability to identify bleeding points during the operation. Here, we describe the advantages of intrauterine evacuation of RPOC using contrast-enhanced ultrasonography (CE-US), which can identify bleeding points and contribute to successful hemostasis, and uterine balloon tamponade (UBT) in four clinical cases. Methods: We encountered four cases of RPOC and performed intrauterine evacuation combined with CE-US and UBT from 2018 to 2019. The ultrasound contrast agent, perfluorobutane, was infused immediately before the operation. After intrauterine evacuation, the uterine balloon was retained. Results: In all cases, CE-US identified bleeding points immediately, enabling retention of the uterine balloon on the bleeding points and subsequent hemostasis. None of the cases experienced complications the day after the operation.