Combined sonographic-pathologic surveillance in elective first-trimester termination of pregnancy

In this study, we attempted to develop a surveillance protocol for elective first-trimester termination to see whether unsuspected ectopic pregnancy could be detected earlier, and to identify those patients with unsuspected second-trimester pregnancies that could be terminated more safely in the hospital. Two hundred fifty consecutive patients requesting elective termination were studied prospectively. All were 12 weeks or less by last menstrual period, had positive urinary pregnancy tests, and had no history of vaginal bleeding. All patients had ultrasound screening before curettage. Immediately after curettage, a "modified" gross pathologic examination (3X magnification) was also performed on unstained curettage material. The sonographic, operative, and pathologic findings were all correlated. Such screening identified four patients with unruptured ectopic pregnancies, who were operated on the same day as the curettage. In addition, four patients, who were actually in the second trimester but had inaccurate dates, were identified and referred to hospital for appropriate methods of termination. We conclude that such surveillance may reduce morbidity in elective terminations and more rapidly identify unsuspected ectopic pregnancies.