Correlation between ultrasound and autopsy findings after 2nd trimester terminations of pregnancy

Antonsson, Per; Sundberg, Anders; Kublickas, Marius; Pilo, Christina; Ghazi, Sam; Westgren, Magnus; Papadogiannakis, Nikos

doi:10.1515/jpm.2008.005

Cited by 35 publications

(43 citation statements)

References 21 publications

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“…OF D&E SPECIMENS There are several studies 18,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] that have reviewed the correlation between prenatal ultrasound and autopsy findings, all based on examination of intact fetuses. Agreement between prenatal ultrasound findings and autopsy diagnosis when autopsy is performed on an intact fetus ranges from 45% to 91.2%.…”

Section: Value Of Careful Examinationmentioning

confidence: 99%

“…These data are typically used to indicate the quality of the prenatal diagnoses, with the autopsy findings representing the gold standard. In addition, several studies 33,35,42,43,46 indicate that the intact fetal autopsy reveals additional important findings not diagnosed prenatally, thus establishing the importance of fetal autopsy both for quality assurance and for diagnosis of disease, with potential implications for family planning, recurrence risk, and genetic counseling.…”

Section: Value Of Careful Examinationmentioning

confidence: 99%

See 1 more Smart Citation

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Ernst

Gawron

Fritsch

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Dilation and evacuation (D&E) is an alternative method to induction of labor for pregnancy termination and intrauterine fetal demise, and it is the most common mode of second-trimester uterine evacuation in the United States. Many D&E specimens are examined in surgical pathology, and there is little information available in surgical pathology textbooks or the literature to assist pathologists in these examinations.Objective.-To provide an overview of the D&E procedure, discuss related legal issues, provide guidelines for routine pathologic examination of D&E specimens, and demonstrate the importance of careful pathologic examination of D&E specimens.Data Sources.-Case-derived material and literature review.Conclusions.-Pathologic examination of D&E specimens has been understudied. However, the available literature and our experience support the fact that careful pathologic examination of D&E specimens can identify significant fetal and placental changes that can confirm clinical diagnoses or provide definitive diagnosis, assist in explaining the cause of intrauterine fetal demise, and identify unexpected anomalies that may provide further clues to a diagnostic syndrome or mechanism of anomaly formation.(Arch Pathol Lab Med. 2013;137:326-337; doi: 10.5858/ arpa.2012-0090-RA) P athologic examination of products of conception in routine surgical pathology practice consists largely of the gross and microscopic examination of fragmented fetal and placental tissue from first-trimester missed or induced abortions. The majority of these pathology specimens are handled grossly by technicians, and for the most part, the main goal is the pathologic documentation of chorionic villi and fetal parts. However, pathologists, especially at large academic medical centers, are encountering an increasing number of disrupted, second-trimester fetal specimens for examination. Prior to the 1970s, uterine evacuation in the second trimester was accomplished via labor induction methods, such as prostaglandin or saline instillation, or by hysterotomy, and resulted in an intact fetus. The development of the dilation and evacuation (D&E) procedure during this time period gave an alternative to these methods. In 1974, only 36% of all midtrimester abortions were managed via D&E, but the safety and popularity of this method increased that number to 96% in 2005. 1 The development of a fellowship in family planning in 1991 has trained a new generation of academic D&E providers. This is a 2-year postgraduate training program for obstetrician-gynecologists and focuses on advanced clinical skills, research, and teaching in the field of contraception and abortion. A total of 179 fellows have graduated, with 79% holding positions in academic centers.2 The addition of a trained fellow to an institution will increase access to D&E services and allow women options for management of an unintended or abnormal pregnancy. Women have been shown to preferentially choose management via D&E over labor induction in the second trimester, avoiding an unpr...

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Section: Value Of Careful Examinationmentioning

confidence: 99%

Section: Value Of Careful Examinationmentioning

confidence: 99%

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Ernst

Gawron

Fritsch

2013

Archives of Pathology &Amp; Laboratory Medicine

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“…Several studies [7][8][9][10] have evaluated whether pathologic evaluation of intact fetal specimens confirms anomalous findings from prenatal ultrasonography. In second-trimester fetuses with known trisomy 21, pathologists found anomalies for 83.1% of 184 specimens, 60% of which were anticipated by ultrasonography.…”

Section: Resultsmentioning

confidence: 99%

“…9 In another study of 112 pregnancy termination specimens, ultrasound and final pathologic evaluation agreed in 45% of cases. 10 Pathologic examination yielded additional information among 40% of specimens. Central nervous system and cardiac anomalies had the greatest discordance between ultrasound and autopsy correlation, a finding consistent with a previous study on D&E specimens.…”

Section: Resultsmentioning

confidence: 99%

Perinatal Pathologic Examination of Nonintact, Second-Trimester Fetal Demise Specimens: The Value of Standardization

Gawron

Hammond

Ernst

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Management of second-trimester intrauterine fetal demise via dilation and evacuation results in nonintact specimens for pathologic examination. Surgical pathology examination is often mandated; however, evidence on expected findings and specimen evaluation guidelines are lacking.Objective.-To assess pathologic findings of nonintact, second-trimester fetal demise specimens, through comparison of anatomic abnormalities identified on standardized perinatal examination to individualized general pathology examinations.Design. ], P , .001). Forty-eight abnormalities were identified: 77.0% (n ¼ 37) were placental and 23.0% (n ¼ 11) were fetal. Chromosomal analysis was done on 73.7% (n ¼ 87 of 118) with 12.6% (n ¼ 11 of 87) showing abnormalities. Among aneuploid specimens, the perinatal pathologist confirmed abnormalities in 66.7% (n ¼ 4 of 6) of cases while general pathologists confirmed abnormalities in 0% (n ¼ 0 of 5) (P ¼ .02).Conclusions.-Systematic surgical pathology examination of nonintact, second-trimester fetal demise specimens yields increased information on fetal or placental abnormalities, which may be clinically useful. Institutions with high-risk obstetrical practices and dilation and evacuation providers should consider integrating a standardized perinatal checklist into educational and practice guidelines.

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“…The importance of fetal autopsy is well established in cases of medical termination of pregnancy (TOP) due to morphological anomalies [8][9][10][11][12][13] . Autopsy is the gold standard to confirm the presence of anomalies diagnosed prenatally but can also identify further anomalies contributing to establish the definitive diagnosis and redefine prognosis.…”

mentioning

confidence: 99%

Clinical Impact of Systematically Performing Autopsies following Selective Termination of Pregnancies: Comparison between Multiples and Singletons

et al. 2014

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Introduction: The aim of this study was to evaluate the clinical impact of systematically performing autopsies following selective termination of pregnancy. Material and Methods: A retrospective study of necropsies following medical termination of pregnancy performed in a tertiary referral hospital. A correlation between prenatal diagnosis and postmortem findings was performed. The cases were classified as having complete agreement, complete disagreement or major agreement with additional information. A comparison between multiples (n = 29) and singletons (n = 374) was undertaken. Results: The median gestational age at the time of termination/selective feticide was 19 (11-34) weeks in multiples and 18 (6-36) weeks in singletons (p = 0.190). In 5 cases (17.2%) of multiples (50.0% submitted to selective feticide) fetal autopsy was not possible, while in singletons autopsy was not feasible in only 1.3% (p < 0.005). Discussion: Contrarily to singleton pregnancies, in twin pregnancies with termination of 1 fetus it should not be possible to undertake an autopsy. When a selective termination is performed away from delivery, the time of retention may hinder the feasibility of the necropsy study. In those cases, it is crucial to make an exhaustive investigation previously to selective feticide.

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Correlation between ultrasound and autopsy findings after 2nd trimester terminations of pregnancy

Cited by 35 publications

References 21 publications

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Perinatal Pathologic Examination of Nonintact, Second-Trimester Fetal Demise Specimens: The Value of Standardization

Clinical Impact of Systematically Performing Autopsies following Selective Termination of Pregnancies: Comparison between Multiples and Singletons

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