Clinical, surgical, and histopathologic outcomes following failed medical abortion

• Published in: International journal of gynecology and obstetrics 2012-06, Vol.117 (3), p.234-238
• Main Authors: Fuchs, Noga, Maymon, Ron, Ben-Ami, Ido, Mendlovic, Sonia, Schneider, David, Pansky, Moty, Halperin, Reuvit
• Format: Article
• Language: English
• Subjects: Abortion, Induced; Antigens, CD - metabolism; Antigens, CD20 - metabolism; Antigens, Differentiation, Myelomonocytic - metabolism; Biological and medical sciences; Birth control; Blood Loss, Surgical; Case-Control Studies; CD3 Complex - metabolism; Endometrium - metabolism; Endometrium - pathology; Failed medical abortion; Female; Fetus - pathology; Gynecology. Andrology. Obstetrics; Humans; Immunohistochemistry; Induced abortion. Therapeutic abortion; Inflammation; Medical sciences; Mifepristone; Necrosis; Obstetrics and Gynecology; Retrospective Studies; Surgical curettage; Treatment Failure; Vacuum Curettage - adverse effects
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2012.01.018

Abstract Objective To address the consequences of surgical curettage following failed medical abortion. Methods A retrospective case–control study was performed in a tertiary gynecologic department. The case group comprised 104 women who underwent surgical curettage following failed medical abortion; the control group included 104 women who underwent early surgically induced abortion. Clinical characteristics and surgical findings were examined. The extent of inflammation was quantified following immunohistochemical staining for cell-surface markers characteristic of T lymphocytes, B lymphocytes, and macrophages. The extent of necrosis was evaluated morphologically. Results Abnormal findings during surgical curettage were significantly more prevalent among women in the case group than in the control group (10.6% versus 1.9%; P = 0.019). The most frequent abnormality in the case group was the presence of intimately adherent products of conception, necessitating sharp curettage. The extent of inflammation (represented by increased numbers of T and B lymphocytes) was greater in the case group than in the control group ( P = 0.046 and P = 0.001, respectively), as was the extent of necrosis ( P < 0.05). Conclusion Curettage following failed medical abortion harbors particular difficulties, which may be attributed to an inflammatory response. The long-term consequences of curettage following failed medical abortion warrant further investigation.