Published: 2017-02-10

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

Veena Vidyasagar


Background: The present study was undertaken to evaluate correlation between ultrasound findings and histological diagnosis in cases which were taken up for uterine evacuation on the suspected diagnosis of retained products of conception (RPOC) following medical abortion.

Methods: A retrospective study was undertaken of cases admitted as RPOC/ failed medical abortion following self-medication for inducing abortion, at Sharda Hospital, Greater Noida. The time period of the study was from 01 Jan 2012 to 31 Aug 2014. The inclusion criteria of cases were H/O intake of drugs for induction of abortion by self-medication, evidence suggestive of RPOC/ failed medical abortion and cases that underwent uterine evacuation. Case documents of patients were studied and the available details noted down. The data were subjected for statistical analysis. Correlation between ultrasound and histopathological findings was evaluated.

Results: There were 243 inpatients, during the study period, which fulfilled the inclusion criteria. Ultrasound was performed in 172 cases. Histopathological examination of specimen was performed in 190 cases. Majority of these (123 - 64.74%) specimen showed features consistent with products of conception. Evidence of products of conception was seen in 64.29% cases with ET 7-10 mm, in 74.07% cases with ET 11-15 mm and in 90.91% cases with ET 16-20 mm on ultrasound.

Conclusions: A retrospective study of suspected cases of RPOC/ failed medical abortion following medical abortion was undertaken. Possibility of products of conception increased with ET increasing from 7 to 20mm. There was also evidence of increase in ET from 7 to 25 mm with increased duration of bleeding PV. 


Retained products of conception, Induction of abortion, Ultrasound, Histopathological examination, ET

Full Text:



Jurkovic D, Ross JA, Nicolaides KH. Expectant management of missed abortion. Br J Obstet Gynecol. 1998;105:670–1.

Grimes DA, Bernstein L, Lacarra M, Shoupe D, Mishell DR Jr. Predictors of failed attempted abortion with the antiprogestin mifepristone (RU 486). Am J Obstet Gynecol. 1990;162:910–5.

Bartley J, Tong S, Everington D, Baird DT. Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases of early medical abortion treated with reduced doses of mifepristone and vaginal gemeprost. Contraception. 2000;62:297–303.

Fiala C, Safar P, Bygdeman M and Gemzell-Danielsson K. Verifying the effectiveness of medical abortion ultrasound versus hCG testing. EurJ Obstet Gynecol Reprod Biol. 2003;109:190–5.

Acharya G, Haugen M, Bråthen A, Nilsen I, Maltau JM. Role of routine ultrasonography in monitoring the outcome of medical abortion in a clinical setting. Acta. Obstetrica et Gynecologica Scandinavica. 2004;83:390–4.

Cowett AA, Cohen LS, Lichtenberg ES, Stika CS. Ultrasound evaluation of the endometrium after medical termination of pregnancy. Obstet Gynecol, 2004;103:871–5.

Machtinger R, Seidman DS, Goldenber M, Stockheim D, Schiff E and Shulman A. Fertility and Sterility. 2005;84:1536–8.

Luise C, Jermy K, May C, Costello G, Collins WP and Bourne T. Outcome of expectant management of spontaneous first trimester miscarriage observational study. BMJ. 2002;324:873–5.

Condous G, Okaro E and Bourne T. The conservative management of early pregnancy complications a review of the literature. Ultrasound Obstet. Gynecol. 2003;22:420–30.

Markovitch O, Tepper R., Klein Z, Fishman A and Aviram R. Sonographic appearance of the uterine cavity following administration of mifepristone and misoprostol for termination of pregnancy. J. Clin. Ultrasound. 2006;34:278–82.

Gal A, Stenning H. Pitfalls in the diagnosis of ectopic pregnancy. Med J Aust. 1985;143:411–412.

Jauniaux E, Kadri R, Hustin J. Partial mole and triploidy: screening patients with first-trimester spontaneous abortion. Obstet Gynecol. 1996;88:616–9.

Nielsen S, Hahlin M. Expectant management of first-trimester spontaneous abortion. Lancet. 1995;345:84.

Lee CY, Madrazo B, Drukker BH. Ultrasonic evaluation of the postpartum uterus in the management of postpartum bleeding. Obstet Gynecol. 1981;58:227–32.

Nielsen S, Hahlin M. Expectant management of first-trimester spontaneous abortion. Lancet. 1995;345:84.

El-Baradie SMY, El-Said MH, Ragab WS, Elssery KM, Mahmoud M. Endometrial Thickness and Serum β-hCG as predictors of the effectiveness of Oral Misoprostol in Early Pregnancy Failure. J Obstet Gynaecol Can. 2008;30(10):877–881.

Rorbye C, Norgaard M. and Nilas L. Prediction of late failure after medical abortion from serial beta-hCG and ultrasonography. Hum. Reprod. 2004;19:85–8.

Rorbye C, Norgaard, Vestermark V. and Nilas L. Medical abortion defining success and categorizing failures. Contraception. 2003;68:247–51.

Machtinger R, Seidman DS, Goldenberg M, Stockheim D, Schiff E. and Shulman A. Fertility and Sterility 2005;84:1536–8.

Blumenfeld F., Abdallah W, Kaplan D. and Nevo O. Endometrial Thickness – A Practical Prospective marker for the Risk of Surgical Intervention after RU486 Induced Abortion. Clinical Medicine: Reproductive Health. 2008:225–30

RCR/RCOG Working Party. Early pregnancy assessment. London: RCOG Press;1996.

Condous G, Okaro E. and Bourne T. The conservative management of early pregnancy complications a review of the literature. Ultrasound Obstet. Gynecol. 2003;22:420–30.

The care of Women requesting induced abortion, Evidence-based Clinical guidelines Number 7; November 2011 RCOG publication

Cooke I, Manek S and MacKenzie IZ. Should tissue from pregnancy termination and uterine evacuation routinely be examined histologically? BJOG. 2000; 107(6):727–730.

Alsibiani SA. Value of Histopathologic Examination of Uterine Products after First-Trimester Miscarriage. BioMed Research International, vol. 2014, Article ID 863482, 5 pages, 2014. Doi:10.1155/2014/863482

Petersen SG, Perkins AR, Gibbons KS, Bertolone JI and Mahomed K. The medical management of missed miscarriage: outcomes from a prospective, single-centre. Australian cohort. Med J Aust. 2013; 199 (5):341-346.

Schaff EA, Fielding SL, Eisinger SH, Stadalius LS, Fuller L. Low-dose mifepristone followed by vaginal misoprostol at 48 hours for abortion up to 63 days. Contraception. 2000;61:41–6.

Mishell DR, Jain JK, Byrne JD, Lacarra MD. A medical method of early pregnancy termination using tamoxifen and misoprostol. Contraception. 1998;58:1–6.

Jain JK, Meckstroth KR, Mishell DR Jr. Early pregnancy termination with intravaginally administered sodium chloride solution-moistened misoprostol tablets: historical comparison with mifepristone and oral misoprostol. Am J Obstet Gynecol.1999;181:1386–91.