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HCG screening at abortion advocated.

Screening for HCG levels about 3 weeks after an elective abortion could save hundreds of women in the United States from the consequences of undiagnosed gestational trophoblastic neoplasia, Michael J. Seckl, Ph.D., and his colleagues reported.

Women seeking a nonmedical termination of pregnancy rarely receive an ultrasound which can be a diagnostic clue to the condition, and the uterine contents are almost never histologically examined. The simplest way to address the problem would be to perform follow-up HCG testing on all women undergoing elective abortion, said Dr. Seckl of the Imperial College London, England (Lancet 2004;364:705-7).

The investigators compared outcomes for 51 women who had an elective abortion just before their diagnosis. The records came from an electronic registry of patients whose gestational trophoblastic neoplasias were treated in the United Kingdom from 1995-2001.

Of these women, 36 had their abortions at a specialist center where pelvic ultrasonography is frequently done. Findings that suggested partial or complete hydatidiform mole prompted a histologic examination of the uterine contents. All of these women were diagnosed with the disease and registered for HCG follow-up.

The remaining 15 women were not diagnosed or registered for HCG follow-up, but presented for care after the abortion. Serious complications from the neoplasia arose in significantly more of these women, compared with controls.

There were no life-threatening complications in the diagnosed group. One 49-year-old woman opted for a hysterectomy. Two women needed chemotherapy, but neither needed a multidrug regimen. (See table.)

By contrast, four of the undiagnosed patients presented 2 months after termination with hypovolemic shock. Three needed laparotomies--including two uterine repairs and one hysterectomy--because of uterine perforations caused by the disease. One patient needed vaginal suturing to control a bleeding metastasis. Two more patients developed placental site trophoblastic tumors and both needed hysterectomies. Nine of the undiagnosed women subsequently needed chemotherapy; four of those needed multidrug therapy.

"Thus, three women with hysterectomies were rendered infertile and two were possibly infertile as a consequence of laparotomy and uterine repair," the researchers said. "These findings show that women have a significantly increased risk of life-threatening complications ... if a diagnosis is not made immediately after termination of pregnancy ... If these women had been registered for HCG follow-up at the time of their pregnancy termination, they might have been prevented from progressing to the potentially lethal condition.... [If] the diagnosis had been made within the first 4-6 weeks following the [termination], it is possible that none of the serious complications reported here would have occurred."

An HCG screening protocol would be easy to establish in the United Kingdom by extending the existing program to abortion centers, Dr. Seckl noted. Urine or serum samples should be obtained about 3 weeks after termination, when normal levels should be expected.

In an accompanying editorial, Benjamin Piura, M.D., of Soroka Medical Centre and Ben-Gurion University of the Negev, Israel, said about 900 U.S women who have an elective abortion each year will have a molar pregnancy. Obviously, he said, "pathological examination of every specimen would be expensive and impossible to implement."

An HCG screening process with serum or urine levels checked at 3 weeks post procedure "seems to be the most practical solution," he said.
Postabortion Histologic Assessment May Help Patients Avoid Interventions

 Histology No Histology
 (n = 36) (n = 15)

Transfusion (for hemorrhage) 0 4
Surgical intervention 1 15
 Hysterectomy 1* 3
Chemotherapy 2 9
 Multidrug regimen 0 4
 Two-drug regimen 1 4
 Single-drug regimen 1 1

Source: Lancet 2004;364:705-7


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Title Annotation:Obstetrics
Author:Sullivan, Michele G.
Publication:OB GYN News
Date:Nov 1, 2004
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