Which method is best to confirm suspicion of retained placental fragments?

Ultrasound is often considered the best initial method to confirm suspicion of retained placental fragments due to its non-invasive nature and accessibility. It allows for real-time imaging of the uterus and can effectively identify the presence of remaining placental tissue. The use of ultrasound provides valuable information regarding the size, location, and condition of any retained fragments, making it an essential tool in postpartum assessments.

While manual exploration can directly reveal retained fragments, it is more invasive and carries risks such as infection or uterine perforation, which makes it less favorable as a first-line diagnostic tool. Hysteroscopy allows for direct visualization of the uterine cavity and can be performed to both diagnose and treat retained products, but it is more invasive and typically reserved for cases where ultrasound suggests significant issues or when other conservative measures have failed. Magnetic resonance imaging (MRI) offers excellent soft tissue contrast and can detect retained placenta, but it is not commonly used in the immediate postpartum period due to cost, availability, and time requirements.

Thus, ultrasound stands out as the most appropriate and effective method for confirming the suspicion of retained placental fragments in a clinical setting.