Should tissue from pregnancy termination and uterine evacuation routinely be examined histologically?

Objective To assess the value of routine histological examination of tissue samples collected at termination of pregnancy in the first trimester and e mergency surgical uterine evacuation. Setting The gynaecological department of a teaching hospital. Design Prospective study of women attending the gynaecological department i n a 12-month period. Participants All women undergoing a therapeutic first trimester medical or surgical abortion or an emergency surgical evacuation of a failed pregnancy , suspected incomplete spontaneous miscarriage or incomplete induced aborti on. Main outcome Association of pre-operative clinical diagnosis and the post-o perative histological result. Results Of 1576 women studied, the histological report confirmed that produ cts of conception were obtained in 1465 (93%); in two women (0.13%) molar c hanges were reported confirming the preoperative diagnosis by ultrasound. P roducts of conception were not confirmed in the tissue specimens in 0.5% me dical terminations, 5% surgical terminations, 10% evacuations following a p revious evacuation, 12% evacuations for a failed pregnancy, and 19% evacuat ions for an incomplete miscarriage. In 87 women (6%), decidua was reported; two of these women had undergone an evacuation for an ultrasound diagnosis of spontaneous miscarriage, but in both a tubal ectopic pregnancy was subs equently diagnosed. Conclusion There did not appear to be any obvious benefit from routine hist ological examination of tissue removed at termination of pregnancy or emerg ency uterine evacuation. The histological result was sometimes not consiste nt with the pre-operative diagnosis and may result in unnecessary further i nvestigation and treatment unless due consideration is given to the clinica l presentation.