AN UPDATED PROTOCOL FOR ABORTION SURVEILLANCE WITH ULTRASOUND AND IMMEDIATE PATHOLOGY

Objective: To modify and improve a protocol for surveillance of patien ts presenting for routine elective abortion services. Methods: Six hun dred seventy-four women presenting for routine elective first-trimeste r abortions were studied. All were 84 or fewer days after the last men strual period, had no history of bleeding, and had positive urine preg nancy tests. Each woman was scanned initially with an empty-bladder tr ansabdominal technique. If no sac was seen, endovaginal ultrasonograph y was performed. All terminations had modified gross examination of ti ssue (3x magnification) as well as staining for microscopic analysis. Results: Six hundred twelve patients (90.8%) demonstrated intrauterine gestations on transabdominal ultrasound, 595 of which were 12 or fewe r weeks. Suction and sharp curettage and examination of tissue reveale d products of conception in all. Seventeen subjects (2.5%) were found to be 13 or more weeks despite bimanual examinations and last menstrua l period suggesting 12 or fewer weeks. Sixty-two patients had no sac s een on transabdominal ultrasound, 34 of whom had definitive intrauteri ne gestations on endovaginal ultrasound. Curettage revealed chorionic villi in all. Two had unruptured definitive ectopic pregnancies seen o n endovaginal ultrasound. Twenty-one women with no sat seen on endovag inal ultrasound underwent curettage as the next step in triage; chorio nic villi proved an intrauterine gestation in 17. The additional four had decidua only on pathology. Rising hCG levels in two of these four led to a diagnosis of ectopic pregnancy, whereas falling hCG levels in the other two led to a presumptive diagnosis of complete abortion, po ssibly tubal pregnancy in light of the lack of vaginal bleeding. Concl usion: Pre-abortion sonography eliminates inadvertent second-trimester cases, and immediate postoperative examination of curettage material expedites the diagnosis of ectopic pregnancy when present. (Obstet Gyn ecol 1944;83: 55-8)