Last reviewed: January 10, 2020

Recommendation:

  • Clinicians performing vacuum aspiration must inspect products of conception immediately after vacuum aspiration.
  • Sending products of conception for routine histopathology evaluation is not recommended.

Strength of recommendation: Strong

Quality of evidence: Very Low

Visual inspection of products of conception

Visual inspection of products of conception is a routine step in vacuum aspiration as recommended by the World Health Organization (WHO, 2014), the Royal College of Obstetricians and Gynaecologists (RCOG, 2015), and the National Abortion Federation (NAF, 2017). Presence of products of conception on visual inspection confirms that the pregnancy was intrauterine and is consistent with successful abortion (Westfall, Sophocles, Burggraf, & Ellis, 1998). If products of conception are not seen, a woman should not leave the facility until plans are made to follow local guidelines to exclude the diagnosis of ectopic pregnancy. Immediate examination of the products of conception expedite the diagnosis of ectopic pregnancy and decrease related morbidity and mortality (Goldstein, Danon, & Watson, 1994). In cases where abnormal pathology is suspected, such as molar pregnancy, histopathology may be used in addition to visual inspection.

Sending products of conception for routine histopathology exam does not affect clinical outcomes and increases the cost of abortion (Heath, Chadwick, Cooke, Manek, & MacKenzie, 2000; Paul, Lackie, Mitchell, Rogers, & Fox, 2002).

Instructions for visually inspecting products of conception are in Ipas’s Woman-Centered Comprehensive Abortion Care Reference Guide, 2nd edition, page 177 (Ipas, 2013).

References

Goldstein, S. R., Danon, M., & Watson, C. (1994). An updated protocol for abortion surveillance with ultrasound and immediate pathology. Obstetrics & Gynecology83(1), 55-58.

Heath, V., Chadwick, V., Cooke, I., Manek, S., & MacKenzie, I. Z. (2000). Should tissue from pregnancy termination and uterine evacuation routinely be examined histologically? BJOG: An International Journal of Obstetrics & Gynaecology107(6), 727-730.

Ipas. (2013). Woman-centered, comprehensive abortion care: Reference manual (second ed.) K. L. Turner & A. Huber (Eds.). Chapel Hill, NC: Ipas.

National Abortion Federation. (2017). Clinical Policy Guidelines. Washington, DC: National Abortion Federation.

Paul, M., Lackie, E., Mitchell, C., Rogers, A., & Fox, M. (2002). Is pathology examination useful after early surgical abortion? Obstetrics & Gynecology99(4), 567-571.

Royal College of Obstetricians and Gynaecologists. (2015). Best practice in comprehensive abortion care. London: Royal College of Obstetricians and Gynaecologists.

Westfall, J. M., Sophocles, A., Burggraf, H., & Ellis, S. (1998). Manual vacuum aspiration for first-trimester abortion. Archives of Family Medicine7(6), 559-62.

World Health Organization. (2014). Clinical practice handbook for safe abortion. Geneva: World Health Organization.