Abstract
Author(s): Jakub Åliwa (ABCDEF), Anna Kryza-Ottou (BCDF), Anna Rosner-Tenerowicz (CFD), Artur Wiatrowski (CDF), Paulina Luty (B), Mateusz Sobalak (B), Maciej Kaczorowski (B), Aleksandra Zimmer (BD), Mariusz Zimmer (DEF)
Introduction. The miscarriage rate among patients who know they are pregnant, is roughly 10 to 15%. An empty gestational sac or a missed or incomplete abortion are all indications for either invasive or pharmacological treatment. In the process uterine products of conception are being examined by histopathologic. The aim of this study was to determine the diagnostic value of miscarriage tissue acquired as the result of either pharmacological or invasive treatment. Material and methods. In this retrospective study we analysed history of 258 patients hospitalised in 2016 within the 2nd Dept. of Obstetrics and Gynaecology, Wroclaw Medical University, with an initial diagnosis of missed abortion or empty gestational sac. We compared the diagnostic value of histopathological reports on the uterine products of conception collected either after pharmacological treatment or after invasive curettage. We analysed collected data using statistical models. Results. Among the analysed patients 232 (92,6%) underwent pharmacological treatment which was the only treatment resulting in completion of miscarriage in 61 patients (23,7%), versus 171 patients (68,9%) who were qualified for curettage of the uterine cavity due to insufficient emptying of the uterine cavity after pharmacological treatment. 16 (6,2%) patients underwent curettage without previous pharmacological treatment. Uterine products consisting of both fetal and maternal tissue has been obtained in 80 cases (35%) after only pharmacological treatment vs in 133 (52%) after curettage. Nondiagnostic histopathological material was observed in 38 patients (15%) after only pharmacological treatment vs in 6 patients (2%) after curettage. Observed differences were statistically significant. Conclusions. Pharmacological treatment of miscarriages has many advantages but it does not guarantee to provide diagnostic material for future histopathological analysis. In all cases of insufficient emptying of the uterine cavity, the invasive approach - curettage - should be advised in order to obtain good quality tissue samples for histopathological analysis.