Value of Histopathologic Examination of Uterine Products after First-Trimester Miscarriage

Abstract

The main rationale of routine histopathologic examination of products after first-trimester miscarriages is to detect an ectopic pregnancy or a molar pregnancy, which require further management. An alternative approach is to examine the products only when there is a definite indication. As there is no agreement, we aimed to study whether routine histopathological examination of tissues obtained after first-trimester miscarriage is of any clinical value in our populations. Medical records of all (558) patients with a diagnosis of first-trimester miscarriage over 4 years (2007–2010) at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, were reviewed. Histopathologic examination confirmed products of conception in 537 (96.2%) patients, no products of conception in 17 (3%) patients, molar pregnancy in 2 (0.4%) patients, and decidual tissues without chorionic villi (Arias-Stella reaction) in 2 (0.4%) patients. After clinical correlation, only one unsuspected partial molar pregnancy was diagnosed by histopathology examination. Conclusion is that it does not appear reasonable to perform histopathological examination routinely after all first-trimester miscarriages in our studied population. We recommend that histopathological examination be performed in select instances: when the diagnosis is uncertain, when fewer tissues have been obtained during surgery, when unexpected pathology was seen, when ultrasound suggests a molar pregnancy, or when patients are considered at high risk for trophoblastic disease.

The role of histopathological examination of the products of conception following first-trimester miscarriage in Erbil Maternity Hospital

“…5 The main role is to detect an ectopic pregnancy, which requires immediate further management, or a molar pregnancy, which needs special follow-up. 4 Other reasons include detecting surgical complications, such as incomplete evacuation after pregnancy failure; determining the cause of recurrent miscarriage; or detecting unexpected fetal pathology. 6 In addition from the Background and objective: Miscarriage represents a common problem that occurs in the first trimester of pregnancy.…”

Comparison between Nursing Performance and Standard of Care for Aborted Woman at Mansoura Hospitals

“…Women who had faced problems related to logistics, women from rural residence, women who are unable to recognize their pregnancy early, and irregular nature of their menses were found to have an abortion in the second trimester period. As regards to item eleven which related to "Analgesia and sedation" the current study results showed that more than half of standards were competent achieved by all studied hospitals and there was highly significance differences among all studied hospitals regarding to standards (1,5,11,13,14,17,18). This results may be due to lack of hospitals resources& facilities and lack of health care provider's knowledge and experiences.…”

Histopathological Changes in the Chorionic Villi and Endometrial Decidual Tissues in the Product of Conception of Spontaneous Abortion Cases

“…In agreement with previous studies the present study also has product of conception as the majority cases from those samples of spontaneous abortion. 10,11 Those studies were investigating the relation of histopathological findings with tissue samples obtained from first-trimester miscarriage, 11 and also exploring whether the routine histopathological examination is required to detect either an ectopic or molar pregnancy. 10,12 Moreover, the histopathological assessment has great value in the identification of different diseases compared to clinical and laboratory findings.…”

“…10,11 Those studies were investigating the relation of histopathological findings with tissue samples obtained from first-trimester miscarriage, 11 and also exploring whether the routine histopathological examination is required to detect either an ectopic or molar pregnancy. 10,12 Moreover, the histopathological assessment has great value in the identification of different diseases compared to clinical and laboratory findings. 12 The present study has revealed that inflammation and fibrin deposition are the major findings in the histopathological examination of decidua.…”

“…[8][9] In addition, findings of histopathological examination could be helpful in the further management of those cases with the history of spontaneous abortion. 10 Therefore, this study was conducted to examine the histopathological changes in the chorionic villi and endometrial decidual tissue in products of conception obtained from women with spontaneous abortion.…”