Early Pregnancy Clinic Referrals

Retained Products of Conception (RPOC) < 3.0 cm in Size

2026 Update

Information for Primary Care Providers

Retained products of conception (RPOC) < 3cm following a first trimester pregnancy loss is common. (Most ultrasounds will demonstrate some evidence of debris or RPOC in the days or weeks following a first trimester loss.)

Current recommendation for RPOC < 3cm without heavy bleeding is expectant management as 90% resolve spontaneously by 6 weeks. Current literature suggests that there is no additional benefit with the addition of misoprostol over expectant management for small RPOC as it does not have higher rates of resolution.

A D&C is not recommended in this scenario as the benefits do not outweigh the risks. D&C’s are associated with higher rates of ongoing RPOC and the risk of intra-uterine adhesions or Asherman’s.

If your patient has menses within 6 weeks of their pregnancy loss no further investigations are needed for the RPOC. (No ultrasound or BHCG testing.)

Patients should follow up in the Early Pregnancy Clinic for labs and ultrasound if they experience:

• Ongoing vaginal bleeding beyond 3 weeks after the pregnancy loss (on average bleeding lasts up to 2 weeks).

• No menses by 6 weeks following the pregnancy loss.

• Signs of infection including fever, pain, increased vaginal bleeding.

Patients with RPOC > 3.0 cm are less likely to resolve spontaneously and a referral to the EPC should be considered.