Prediction of late failure after medical abortion from serial  -hCG measurements and ultrasonography

Abstract

Neither beta-hCG nor endometrial thickness can be used clinically as diagnostic tests in predicting late failure after medical abortion.

Correlation between ultrasound and histopathological findings of products of uterine evacuation in cases admitted after medical abortion

“…18 The cut-off values of endometrial thickness have not been prospectively validated. 17 Reasons for curettage usually have included retained intrauterine pregnancy, or massive bleeding. It is expected that the intrauterine debris presented after medical abortion will be expelled in the next menstruation.…”

“…21 However, these cut-off values have never been prospectively validated. 23 Neither [beta]-hCG nor endometrial thickness can be used clinically as diagnostic tests in predicting late failure after medical abortion as per the study by Rorbye et al 17 Routine histopathological examination of tissue obtained at abortion procedures is not recommended as per RCOG guidelines. 23 Guidelines also recommend that ultrasound examination should not be used routinely to screen women for incomplete abortion.…”

“…17 Histological examination would seem logical in women with an uncertain pre-operative diagnosis, when less tissue than expected has been obtained, when trophoblastic tissue is not readily identified at surgery, or if routine inspection during the operation suggests that there may be unexpected pathology. The care of the woman thereafter should take into account not only the histological findings but also her initial history and clinical examination and her subsequent symptoms.…”

“…Rorbye et al 17 concluded that the clinical presentation is more accurate than sonographic measurement of the endometrial thickness for defining failure of medical TOP, 14-30 days after treatment. Extended follow-up, in this study, was linked to higher rate of surgical intervention.…”

Endometrial Thickness- a Practical Prospective Marker for the Risk of Surgical Intervention after RU486 Induced Abortion

“…To avoid unnecessary interventions, the positive predictive value of such an applied test must be high. The specifi city should be more than 95%, which is the approximate chance of a successful course using this medical abortion regimen (15).…”