Medical termination of pregnancy (MTOP) is indicated when the continuation of pregnancy threatens maternal physical or mental health, or in the presence of severe fetal anomalies. While MTOP can be carried out at any gestational age, surgical evacuation becomes technically challenging beyond the first trimester due to the increased fetal size. In France, second and third trimesters terminations are primarily managed by labor induction to achieve vaginal delivery [1,2].

Retained placenta, defined as the persistence of placental tissue within the uterine cavity after delivery, occurs in approximately 1 % of term pregnancies and is more commonly observed following miscarriage or termination of pregnancy [3]. It can lead to immediate or delayed hemorrhage, pelvic pain and infection, often requiring intrauterine intervention in 5–30 % of cases [4]. As one of the leading causes of postpartum hemorrhage, retained placenta significantly contributes to maternal morbidity and mortality [[5], [6], [7]].

The diagnosis of retained placenta is primarily clinical, based on abnormal bleeding, pelvic pain, fever, or incomplete placental expulsion at the time of delivery. Ultrasound may also assist in diagnosis, even in asymptomatic patients. Sonographic findings suggestive of retained products include endometrial thickening or the presence of an intrauterine mass with a heterogeneous appearance, with or without Doppler vascularization [3]. Intrauterine procedures such as manual uterine revision or aspiration are often performed to evacuate suspected retained placenta. However, these procedures are associated with short-term complications, including uterine perforation, intrauterine infection, and persistent bleeding, as well as long-term complications, such as intrauterine adhesions and fertility disorders [8].

Currently, no official guidelines exist for the management of suspected retained placenta after MTOP, especially for post-delivery ultrasound assessment to guide decision to perform intrauterine procedures. Additionally, there is limited data in the literature regarding predictive factors associated with the need for intrauterine procedures after MTOP [3,4,[9], [10], [11]].

Based on these observations, we carried out a study to identify factors associated with intrauterine procedures for suspected retained placenta during MTOP in the 2nd and 3rd trimesters, in order to better inform clinical decision-making regarding the performance of these procedures.