Is tissue an issue? Current practice and opinion in Western Australia for routine histopathology on products of conception

Abstract

An anonymous questionnaire-based survey was used to determine current practices and opinions of senior health professionals working in Western Australian (WA) hospitals performing gynaecological procedures, regarding the routine use of histopathology for products of conception (POC) obtained either from the surgical management of miscarriage or termination of pregnancy. Sixty-one senior health professionals completed the survey. Tissue histopathology on POC was routinely requested for miscarriage and termination of pregnancy (TOP) by 87 and 59% of respondents, respectively. Respondents listed the main reasons for requesting routine histopathology as avoidance of misdiagnosis, medico-legal and quality assurance. There were inconsistent practices among WA health professionals regarding sending POC for histopathology; 63% of gynaecology head of departments recommend the introduction of state or national guidelines for the use of histopathology in the surgical management of miscarriages or terminations of pregnancy.

Histopathological Account of Obstetrical and Gynecological Specimens: Retrospective Study at a Tertiary Care Center of Peshawar

“…Sending products of conception for routine histopathology is a known dilemma, 19.6% of our center's uterine samples showed products of conception as a result. In a short communication published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, it was stated that the commonest reason these samples are sent for histopathology is to avoid misdiagnosis [ 18 ]. This could be a genuine reason however, patients' financial status needs to be taken into account as well.…”

Comparison of the diagnostic value of histopathological examinations of miscarriage products after pharmacological induction of miscarriage and curettage

“…In the literature, there is an ongoing debate on the legitimacy of the routine histopathological examination of tissues obtained after miscarriage [13,[15][16][17][18][20][21][22][23]. One of the aims of the histopathological examination of gestational tissues is the detection of trophoblast pathology such as gestational trophoblastic disease, molar pregnancy, and choriocarcinoma.…”

“…Other information from histopathological examinations can play a role in the diagnostic process, such as the detection of chromosomal aberrations in fetal tissues and other facts helpful for determining the location of pregnancies of unknown location. Those should be considered as further arguments for conducting routine histopathological examinations [13,[15][16][17][18]20]. Heath et al claim that the frequency of disorders diagnosed by histopathological examination is low and does not support routine tests.…”

“…The legitimacy of routine histopathological assessment of uterine products of miscarriage is currently under debate [13][14][15][16][17][18][19][20][21][22][23]. Some authors opt for routine histopathological examination of gestational tissues as a necessary supplement to the miscarriage therapy because it enables treatment maintenance in the case of a proliferative pathology of the trophoblast [13][14][15][16][17][18][19]. An additional argument for histopathological examination is the possibility to obtain guidance on the necessity of further tests (e.g., genetic tests) and help make the final diagnosis in cases with pregnancy of unknown location [15][16][17][18].…”

“…Some authors opt for routine histopathological examination of gestational tissues as a necessary supplement to the miscarriage therapy because it enables treatment maintenance in the case of a proliferative pathology of the trophoblast [13][14][15][16][17][18][19]. An additional argument for histopathological examination is the possibility to obtain guidance on the necessity of further tests (e.g., genetic tests) and help make the final diagnosis in cases with pregnancy of unknown location [15][16][17][18]. Other group of researchers claims that the routine histopathological examination has no justification, and recommended only in particular cases when ultrasound examination suggests features of trophoblast pathology or in patients with habitual miscarriages as well as when the results of the histopathologic examination are required for the diagnosis [7,[21][22][23].…”