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The utility of embryofeto-pathology following surgical terminations of pregnancy

University of British Columbia

Embryofeto-pathology examination findings for 521 consecutive pregnancy terminations for fetal abnormalities were compared on the basis of method of termination, results of prenatal cytogenetic investigations, and gestational age at termination. Comparisons were undertaken to ascertain if, as generally assumed, the amenability of the products of conception to embryofeto-pathological examination is less following pregnancy termination by surgical means than following termination by induction. Embryofeto-pathological examination provided a diagnosis that could be used for genetic counseling 42.2 (95% C.I. = 5.45 - 327.04) times more often following termination by induction, as compared to termination by surgical procedures. Pregnancy termination was performed by surgical procedure 2.17 (95% C.I. = 1.39- 3.39; P = 0.0006) times more often when the fetus was identified prenatally to be karyotypically abnormal and 0.72 (95% C.I. = 0.66 - 0.78; P < 0.0001) times less often with each one week increase in the estimated gestational age at termination between 10 and 24 weeks. Among terminated pregnancies with specific ultrasound diagnosed fetal abnormalities, the ability to evaluate ultrasound-identified fetal abdominal wall defects was 30.60 (95% C.I. = 1.63 - 575.84; P = 0.00107) and cystic hygroma was 146.18 (95% C.I. = 7.97 - 2680.93; P < 0.00001) times less likely at autopsy following surgical termination procedures as compared to terminations by induction. The ability to evaluate ultrasound identified fetal anencephaly 8.91 (95% C.I. = 0.39 - 202.07; P = 0.15), cystic kidney disease (odds ratio N/A, P = N/A), diaphragm defects 19.00 (95% C.I. = 0.83 - 434.47; P = 0.03), fetal hydrops 9.00 (95% C.I. = 0.45 - 178.12; P = 0.13), and structural heart defects 21.00 (95% C.I. = 1.08 - 409.15; P=0.01) times less likely following surgical termination procedures as compared to terminations by induction. As multiple tests were performed on the data, a critical P value of 0.00385 was used to test for significance. The trend in each case was for surgical termination to be informative less frequently than medical termination. Among pregnancies terminated with any prenatally diagnosed fetal abnormality, the ability to evaluate the CNS tissue was 36.20 (95% C.I. = 21.77 - 60.19; p<0.00001), heart was 16.76 (95% C.I. = 5.18 - 54.24; p 0.0000l) and kidneys was 5.04 (95% C.I. = 1.74 - 14.61; p=0.0005) times less likely at autopsy following surgical pregnancy termination procedures, as compared to termination by induction. The ability to evaluate the CNS tissue, heart and kidneys at autopsy following surgical termination procedures were found to be 1.26 (95% C.I. = 1.1 - 1.44; P = 0.0008), 1.19 (95% C.I. = 1.07 - 1.32; P = 0.0012) and 1.35 (95% C.I. = 1.15 - 1. 58; P = 0.0001) times, respectively, more likely for each one week increase in the estimated gestational age at termination. The results of these comparisons confirm that the amenability of the products of conception to embryofeto-pathological examination is reduced following surgical termination procedures, as compared to medical termination procedures. This may have important clinical implications for women considering pregnancy termination following ultrasound diagnosis of fetal abnormalities.

Thesis/Dissertation

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2009-04-28

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http://hdl.handle.net/2429/7636

Medical Genetics

University of British Columbia

UBCV

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