Is pathology examination useful after early surgical abortion?
OBJECTIVE
To study if the pathologist's examination of surgical abortion tissue offers more information than immediate fresh tissue examination by the surgeon. Immediate examination of the fresh tissue aspirate after surgical abortion helps reduce the risk of failed abortion and other complications. Regulations in some states also require a pathologist to analyze abortion specimens at added cost to providers. We conducted this study to evaluate the incremental clinical benefit of pathology examination after surgical abortion at less than 6 weeks' gestation.


METHODS
As part of a prospective case series of women who had early surgical abortions at the Planned Parenthood League of Massachusetts during a 32-month period, we collected data on clinical outcomes and the results of postoperative tissue examinations. Using outcomes verified by in-person follow-up as the "gold standard," we calculated the validity of the tissue examinations by the surgeons and the outside pathologists.


RESULTS
A total of 676 women had documented outcomes and complete tissue examination data. The sensitivity (ability of the examiner to detect an outcome other than complete abortion) was 57% (95% confidence interval [CI] 35, 76) for the surgeons' tissue inspections and 22% (95% CI 8, 44) for the pathologists' examinations. The predictive value of a positive (abnormal) tissue screen was 14% (95% CI 8, 24) and 7% (95% CI 3, 17) for the surgeons and pathologists, respectively.


CONCLUSIONS
Routine pathology examination of the tissue aspirate after early surgical abortion confers no incremental clinical benefit. Although the surgeons' tissue inspections predicted abnormal outcomes poorly, the pathologists did no better. Our results challenge the rationale for state regulations requiring pathologic analysis of all surgical abortion specimens.
Paul
Maureen
M
Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA. maureen_paul@pplm.org
Lackie
Elyse
E
Mitchell
Caroline
C
Rogers
Angela
A
Fox
Michelle
M
D000027:Abortion, Incomplete / Q000473:pathology*; D000029:Abortion, Legal / Q000009:adverse effects / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data*; D000030:Abortion, Missed / Q000473:pathology; D000328:Adult; D005193:Family Planning Services / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006306:Health Surveys; D006801:Humans; D008404:Massachusetts; D010338:Pathology, Clinical / Q000191:economics; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014619:Vacuum Curettage / Q000009:adverse effects / Q000191:economics