Perinatal Pathologic Examination of Nonintact, Second-Trimester Fetal Demise Specimens: The Value of Standardization

Gawron, Lori M.; Hammond, Christopher J.; Ernst, Linda M.

doi:10.5858/arpa.2012-0010-oa

Cited by 67 publications

(7 citation statements)

References 12 publications

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“…However, fragmented fetuses are mostly dissected in surgical pathology and finalized by pathologists who do not normally perform fetal autopsy. A study 21 at our institution has shown that in the hands of general surgical pathologists the examination of D&E specimens lacks important findings that are seen by more experienced, trained perinatal pathologists. Because not all institutions can employ a fetal/perinatal pathologist, there is a need for general pathologists to begin to acquire skills necessary to adequately examine tissues from D&E specimens.…”

Section: Standard Of Care For Pathologicmentioning

confidence: 98%

“…So, it is logical to infer that evaluation of IUFD in D&E specimens, if performed rigorously, should also be useful in evaluating cause of fetal death. Our group 21 has recently performed an institutional retrospective chart review to assess the findings of pathologic examination of disrupted second-trimester fetal demise specimens. 118 specimens were evaluated between May 2006 and October 2010, and the findings of a perinatal pathologist were compared with those examined by general pathologists.…”

Section: 54mentioning

confidence: 99%

“…Similar to the conclusions from many of the autopsy studies, we concluded that implementation of a standardized, anatomic examination on disrupted D&E specimens from second-trimester fetal loss frequently confirms clinically suspected anomalies and identifies unanticipated fetal or gestational abnormalities, and that these findings yield clinically useful information for patient counseling. 21 Further studies are needed to determine if the examination of D&E specimens for IUFD is more limited than an autopsy and placental examination on an intact fetus.…”

Section: 54mentioning

confidence: 99%

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Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Ernst

Gawron

Fritsch

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Dilation and evacuation (D&E) is an alternative method to induction of labor for pregnancy termination and intrauterine fetal demise, and it is the most common mode of second-trimester uterine evacuation in the United States. Many D&E specimens are examined in surgical pathology, and there is little information available in surgical pathology textbooks or the literature to assist pathologists in these examinations.Objective.-To provide an overview of the D&E procedure, discuss related legal issues, provide guidelines for routine pathologic examination of D&E specimens, and demonstrate the importance of careful pathologic examination of D&E specimens.Data Sources.-Case-derived material and literature review.Conclusions.-Pathologic examination of D&E specimens has been understudied. However, the available literature and our experience support the fact that careful pathologic examination of D&E specimens can identify significant fetal and placental changes that can confirm clinical diagnoses or provide definitive diagnosis, assist in explaining the cause of intrauterine fetal demise, and identify unexpected anomalies that may provide further clues to a diagnostic syndrome or mechanism of anomaly formation.(Arch Pathol Lab Med. 2013;137:326-337; doi: 10.5858/ arpa.2012-0090-RA) P athologic examination of products of conception in routine surgical pathology practice consists largely of the gross and microscopic examination of fragmented fetal and placental tissue from first-trimester missed or induced abortions. The majority of these pathology specimens are handled grossly by technicians, and for the most part, the main goal is the pathologic documentation of chorionic villi and fetal parts. However, pathologists, especially at large academic medical centers, are encountering an increasing number of disrupted, second-trimester fetal specimens for examination. Prior to the 1970s, uterine evacuation in the second trimester was accomplished via labor induction methods, such as prostaglandin or saline instillation, or by hysterotomy, and resulted in an intact fetus. The development of the dilation and evacuation (D&E) procedure during this time period gave an alternative to these methods. In 1974, only 36% of all midtrimester abortions were managed via D&E, but the safety and popularity of this method increased that number to 96% in 2005. 1 The development of a fellowship in family planning in 1991 has trained a new generation of academic D&E providers. This is a 2-year postgraduate training program for obstetrician-gynecologists and focuses on advanced clinical skills, research, and teaching in the field of contraception and abortion. A total of 179 fellows have graduated, with 79% holding positions in academic centers.2 The addition of a trained fellow to an institution will increase access to D&E services and allow women options for management of an unintended or abnormal pregnancy. Women have been shown to preferentially choose management via D&E over labor induction in the second trimester, avoiding an unpr...

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Section: Standard Of Care For Pathologicmentioning

confidence: 98%

Section: 54mentioning

confidence: 99%

Section: 54mentioning

confidence: 99%

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Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Ernst

Gawron

Fritsch

2013

Archives of Pathology &Amp; Laboratory Medicine

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“…For active CD during pregnancy, infliximab may be continued up to birth [Van Assche et al 2010]. Infliximab is compatible with breastfeeding since only a small amount is excreted in human milk and is poorly absorbed orally; it thus has low potential to reach detectible levels in the newborn [Ben-Horin et al 2011;Gawron et al 2013].…”

Section: Infliximabmentioning

confidence: 99%

From historical perspectives to modern therapy: a review of current and future biological treatments for Crohn’s disease

Randall

Vizuete

Martinez

et al. 2015

Therap Adv Gastroenterol

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Crohn's disease (CD) is a debilitating, systemic inflammatory disorder with both gastrointestinal and extraintestinal manifestations. Its existence predates modern medicine, but its precise etiology remains incompletely understood. Most authorities suggest a multifactorial pathogenesis owing to a mixture of genetic disorders, immunologic dysregulation, microbiota disequilibrium and environmental influences. Of these factors, the overactive immunologic response seen in CD appears to be the most promising target of medical therapy. Biological agents comprise a relatively new class of drugs that can induce and maintain remission in moderate to severe CD, as well as in ulcerative colitis. This review will provide an overview of CD, its history, clinical features, pathophysiology, and treatment options focusing on current and future biological agents with an emphasis on drug development, dosage and administration.

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“…[7][8][9][10] As one might expect, this is particularly true if pathologists with expertise in perinatal or pediatric pathology examine the specimens. 11 The aim of our study was to correlate pathology findings with prenatal diagnoses in a large series of D&E procedures done for fetal abnormalities. An important focus was to determine the utility of pathology examination of fragmented specimens to supplement or correct clinical diagnoses in an extensive range of disorders.…”

mentioning

confidence: 99%

Correlation of Prenatal Diagnosis and Pathology Findings Following Dilation and Evacuation for Fetal Anomalies

Boecking¹,

Drey²,

Kerns³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Despite increased use of dilation and evacuation in the setting of fetuses with developmental anomalies, the pathology examination of fragmented specimens obtained by this technique has been understudied.Objectives.-To correlate pathologic findings in secondtrimester fetal dilation and evacuation specimens with prenatal diagnoses established through ultrasound and/or chromosome studies to determine the value of pathology examination for supplementing or correcting clinical diagnoses.Design.-In this retrospective study, clinical and pathology findings were correlated in 448 dilation and evacuation specimens performed for second-trimester termination of pregnancy for fetal anomalies discovered on ultrasound examination (278 cases) or chromosome analysis (170 cases).Results.-In 109 of the 170 cases with chromosomal abnormalities (64%), pathologists identified at least 1 congenital defect associated with the respective karyotype. In 278 cases with ultrasound-detected anomalies, pathologists confirmed the major congenital defect in 116 fetal specimens (42%). Evaluating for congenital central nervous system and body wall/diaphragm pathologic findings proved challenging owing to tissue disruption. However, taking all categories into account, pathology studies corrected ultrasound diagnoses in 152 of 413 cases (37%) and yielded additional diagnostic findings in 137 cases (33%).Conclusions.-In a substantial number of cases, examination of fragmented fetuses corrected or refined prenatal diagnoses, demonstrating a role for detailed pathology examination of dilation and evacuation specimens in quality control of prenatal imaging studies and for potentially aiding subsequent genetic counseling. W hile pathology examinations generally are recognized as the gold standard for confirming clinical diagnoses, dilation and evacuation (D&E) procedures typically provide fragmented and/or incomplete fetal specimens, making clinicopathologic correlations difficult, imperfect, or impossible. Although induction terminations offer the advantage of providing intact specimens, 1-3 studies indicate that most women terminating pregnancy for fetal anomalies prefer D&E. [3][4][5][6] Despite the increasing use of D&E in the setting of fetuses with developmental anomalies, the pathology examination of nonintact fetal specimens obtained by this technique has been understudied. Uncertainty as to whether prenatal diagnosis can be confirmed after D&E may lead to counseling women to undergo induction solely for the purpose of obtaining a fetal autopsy. However, all studies investigating clinicopathologic correlations of specimens obtained from D&E-terminated pregnancies-whether performed for structural or chromosomal abnormalitiesindicate that careful examination of fragmented fetal specimens is valuable and may confirm, supplement, or correct diagnoses. 7-10 As one might expect, this is particularly true if pathologists with expertise in perinatal or pediatric pathology examine the specimens. 11 The aim of our study was to correlate patholo...

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Perinatal Pathologic Examination of Nonintact, Second-Trimester Fetal Demise Specimens: The Value of Standardization

Cited by 67 publications

References 12 publications

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

From historical perspectives to modern therapy: a review of current and future biological treatments for Crohn’s disease

Correlation of Prenatal Diagnosis and Pathology Findings Following Dilation and Evacuation for Fetal Anomalies

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