CLINICAL AND HISTOPATHOLOGICAL CORRELATION IN FIRST-TRIMESTER PREGNANCY LOSS:AN OBG–PATHOLOGY COLLABORATIVE STUDY

Abstract

Background: First-trimester pregnancy loss is common and represents a major clinical and emotional burden. Histopathological examination of products of conception (POC) can confirm intrauterine gestational tissue and occasionally identify clinically important entities such as hydatidiform mole, abnormal implantation-site trophoblast and other uncommon lesions.
Aim: To study the clinicopathological profile of women presenting with first-trimester pregnancy loss and to evaluate the histopathological spectrum of products of conception, with emphasis on clinical–pathological correlation.
Methods: A hospital-based observational study was done on 100 women with pregnancy loss up to 12 completed weeks who underwent uterine evacuation or submitted products of conception for histopathological examination. Demographic variables, gestational age, clinical presentation, ultrasound diagnosis, management and histopathological findings were recorded. Tissue was fixed in 10% neutral buffered formalin, routinely processed and stained with hematoxylin and eosin. Hydropic/molar-appearing specimens were considered for p57 immunohistochemistry as an ancillary test. Descriptive statistics and cross-tabulation were used.
Results: The cohort had a mean maternal age of 30.8 ± 6.2 years and mean gestational age of 8.3 ± 2.0 weeks. Vaginal bleeding was the commonest presenting symptom (84%), followed by lower abdominal pain/cramping (62%). Incomplete miscarriage was the most frequent clinical diagnosis (40%), followed by missed miscarriage (32%), anembryonic pregnancy loss (18%) and inevitable miscarriage (10%). Histopathology showed non-molar products of conception with chorionic villi and decidua in 75%, hydropic abortion in 10%, partial hydatidiform mole in 5%, complete hydatidiform mole in 2%, decidual tissue without chorionic villi in 7% and exaggerated implantation-site/placental-site trophoblastic change in 1%. Seven molar pregnancies were identified, including three not suspected before histopathological review.
Conclusion: Histopathological examination of POC provides useful clinicopathological correlation in first-trimester pregnancy loss and can occasionally identify unexpected molar or implantation-site pathology. Correlation with ultrasound and β-hCG is particularly important when chorionic villi are absent or hydropic villi are encountered.