Comparison of the diagnostic value of histopathological examinations of miscarriage products after pharmacological induction of miscarriage and curettage
, 1, 1, 2, 1, 3
Abstract
Objectives: For early miscarriage (pregnancy loss ≤ 12 weeks of gestation), two types of therapeutic treatment are offered (pharmacotherapy and curettage of the uterine cavity) depending on the presence and severity of clinical symptoms as well as patient choice. Our study aimed to assess the diagnostic value of the results of histopathological examinations of miscarriage products in relation to the administered treatments.
Material and methods: 850 medical records from patients diagnosed with missed miscarriage or empty gestational sac were analyzed retrospectively. Patients underwent surgical treatment or pharmacotherapy. Inefficacy of pharmacotherapy resulted in subsequent curettage. The results of histopathology were evaluated for their diagnostic value and classified: subgroup 1 — high value specimen (the studied specimen included fetal tissues, and villi), and subgroup 2 — no-diagnosis (the studied specimen included maternal tissues, autolyzed tissues, blood clots). Data were compared with chi-squared test. Differences was considered significant at p < 0.05.
Results: 1128 histopathological test results were analyzed; 569 (50.4%) were obtained during pharmacotherapy and 559 (49.6%) after curettage; out of the latter 497 after the initial pharmacotherapy and 62 after surgery. In the pharmacotherapy group, high value specimens comprised 231 cases (40.59%) while no diagnosis was obtained in 338 cases (59.4%). Considering specimens obtained in the course curettage, high value specimens were found in 364 cases (65.1%) while results that did not allow a diagnosis to be made were found in 195 cases (34.9%).
Conclusions: Tissue specimens of high diagnostic value are obtained significantly more often during surgical treatment of miscarriage than during pharmacotherapy.
Keywords: curettagemiscarriagespontaneous abortionhistologydifferential diagnosis
References
- Poland BJ, Miller JR, Jones DC, et al. Reproductive counseling in patients who have had a spontaneous abortion. Am J Obstet Gynecol. 1977; 127(7): 685–691.
- WARBURTON D, FRASER FC. SPONTANEOUS ABORTION RISKS IN MAN: DATA FROM REPRODUCTIVE HISTORIES COLLECTED IN A MEDICAL GENETICS UNIT. Am J Hum Genet. 1964; 16: 1–25.
- Doubilet PM, Benson CB, Bourne T, et al. Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy, Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 2013; 369(15): 1443–1451.
- Lemmers M, Verschoor MAC, Bossuyt PM, et al. MisoREST study group. Cost-effectiveness of curettage vs. expectant management in women with an incomplete evacuation after misoprostol treatment for first-trimester miscarriage: a randomized controlled trial and cohort study. Acta Obstet Gynecol Scand. 2018; 97(3): 294–300.
- Kim C, Barnard S, Neilson JP, et al. Medical treatments for incomplete miscarriage. Cochrane Database Syst Rev. 2017; 1: CD007223.
- Demetroulis C, Saridogan E, Kunde D, et al. A prospective randomized control trial comparing medical and surgical treatment for early pregnancy failure. Hum Reprod. 2001; 16(2): 365–369.
- Alsibiani SA. Value of histopathologic examination of uterine products after first-trimester miscarriage. Biomed Res Int. 2014; 2014: 863482.
- Tomasik P, Zwierzchowska A, Barcz E. Assessment of patient acceptability of medical treatment in case of non-viable first trimester pregnancy. Ginekol Pol. 2015; 86(5): 383–387.
- Luise C, Jermy K, May C, et al. Outcome of expectant management of spontaneous first trimester miscarriage: observational study. BMJ. 2002; 324(7342): 873–875.
- Jurkovic D, Ross JA, Nicolaides KH. Expectant management of missed miscarriage. Br J Obstet Gynaecol. 1998; 105(6): 670–671.
- Bagratee JS, Khullar V, Regan L, et al. A randomized controlled trial comparing medical and expectant management of first trimester miscarriage. Hum Reprod. 2004; 19(2): 266–271.
- Ngai SW, Chan YM, Tang OS, et al. Vaginal misoprostol as medical treatment for first trimester spontaneous miscarriage. Hum Reprod. 2001; 16(7): 1493–1496.
- Novak RW, Malone JM, Robinson HB. The role of the pathologist in the evaluation of first trimester abortions. Pathol Annu. 1990; 25 Pt 1: 297–311.
- Rashid P. The role of histopathological examination of the products of conception following first-trimester miscarriage in Erbil Maternity Hospital. Zanco Journal of Medical Sciences. 2017; 21(3): 1938–1942.
- Tasci Y, Dilbaz S, Secilmis O, et al. Routine histopathologic analysis of product of conception following first-trimester spontaneous miscarriages. J Obstet Gynaecol Res. 2005; 31(6): 579–582.
- Yap SJ, Watts JC, Faithfull TJ, et al. Is tissue an issue? Current practice and opinion in Western Australia for routine histopathology on products of conception. Aust N Z J Obstet Gynaecol. 2014; 54(5): 493–496.
- Szulman AE, Ma HK, Wong LC, et al. Residual trophoblastic disease in association with partial hydatidiform mole. Obstet Gynecol. 1981; 57(3): 392–394.
- Bagshawe KD, Lawler SD, Paradinas FJ, et al. Gestational trophoblastic tumours following initial diagnosis of partial hydatidiform mole. Lancet. 1990; 335(8697): 1074–1076.
- Hinshaw K, Fayyad A, Munjuluri P. The management of early pregnancy loss. http://www.jsog.org/GuideLines/The_management_of_early_pregnancy_loss.pdf (25.04.2018).
- Fram KM. Histological analysis of the products of conception following first trimester abortion at Jordan University Hospital. Eur J Obstet Gynecol Reprod Biol. 2002; 105(2): 147–149.
- Heath V, Chadwick V, Cooke I, et al. Should tissue from pregnancy termination and uterine evacuation routinely be examined histologically? BJOG. 2000; 107(6): 727–730.
- Jauniaux E, Kadri R, Hustin J. Partial mole and triploidy: screening patients with first-trimester spontaneous abortion. Obstet Gynecol. 1996; 88(4 Pt 1): 616–619.
- Gal A, Stenning H. Pitfalls in the diagnosis of ectopic pregnancy. Med J Aust. 1985; 143(9): 411–412.
- NICE. Ectopic pregnancy and miscarriage: diagnosis and initial management. Clinical guideline [CG154]. https://www.nice.org.uk/guidance/cg154/resources/surveillance-report-2017-ectopic-pregnancy-and-miscarriage-diagnosis-and-initial-management-2012-nice-guideline-cg154-4367146717/chapter/Surveillance-decision 2012 (30.07.2018).
- Cox P, Evans C. Tissue pathway for histopathological examination of the placenta. http://www.rcpath.org/publications-media/publications/datasets/tissue-pathway-placenta (30.06.2018).
- NHS Commissioning Board. E12/S/b - 2013/14 NHS Standard Contract for Perinatal Pathology. https://www.england.nhs.uk/wp-content/uploads/2013/06/e12-perinatal-path.pdf 2013 (30.06.2018).
- Petersen SG, Perkins AR, Gibbons KS, et al. The medical management of missed miscarriage: outcomes from a prospective, single-centre, Australian cohort. Med J Aust. 2013; 199(5): 341–346.
- Sur SD, Raine-Fenning NJ. The management of miscarriage. Best Pract Res Clin Obstet Gynaecol. 2009; 23(4): 479–491.
- Petrou S, Trinder J, Brocklehurst P, et al. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). BMJ. 2006; 332(7552): 1235–1240.
- Sotiriadis A, Makrydimas G, Papatheodorou S, et al. Expectant, medical, or surgical management of first-trimester miscarriage: a meta-analysis. Obstet Gynecol. 2005; 105(5 Pt 1): 1104–1113.
- Graziosi GCM, Bruinse HW, Reuwer PJH, et al. Misoprostol versus curettage in women with early pregnancy failure: impact on women's health-related quality of life. A randomized controlled trial. Hum Reprod. 2005; 20(8): 2340–2347.
- Kitange B, Matovelo D, Konje E, et al. Hydatidiform moles among patients with incomplete abortion in Mwanza City, North western Tanzania. Afr Health Sci. 2015; 15(4): 1081–1086.
- Biscaro A, Silveira SK, Locks Gd, et al. [Frequency of hydatidiform mole in tissue obtained by curettage]. Rev Bras Ginecol Obstet. 2012; 34(6): 254–258.
