Is pathology examination useful after early surgical abortion?

Neuropathological microscopic features of abortions induced by Bunyavirus / or Flavivirus infections

Background

The present study describes the pathologic changes in the brain and the spinal cord of aborted, stillbirth and deformities of newborn lambs infected with viral agents.

Methods

From February 2012 to March 2013, a total of 650 aborted fetuses from 793 pregnant ewes were studied from 8 flocks at different areas in the Mazandaran province in the north of Iran. And randomly, systematic necropsy was performed to collect tissues, and all gross abnormalities were recorded at necropsy by the pathologist .Nevertheless, we conducted a limited number of necropsies for aborted fetuses.

Results

In the most cases, arthrogryposis was the most common musculoskeletal defects and at necropsy, malformations of the brain included hydranencephaly, porencephaly, hydrocephalus and cerebellar hypoplasia, mainly in the brain stem and gray and white matter of the brain and cerebellum were observed. Histopathologic lesions included chronic multifocal lymphoplasmacytic encephalitis(nonsuppurative) with extensive perivascular cuffing in some cases, formation of glial nodules mainly in the mesencephalon, thalamus, hippocampus, pons and medulla oblongata in the brain of aborted fetuses, and neuronal degeneration, necrosis and central chromatolysis mainly in the cortex and subcortical of the brain and brain stem regions of them. Furthermore, microscopic lesions are mostly linked to a neurodegenerative and necrotic cell death process in the gray matter of ventral horn of the spinal cord. Briefly, histopathologic findings in the brain and spinal cord included hyperemia, hemorrhage, non-suppurative encephalitis, mononuclear perivascular cuffing, multifocal gliosis, cavitation, central chromatolysis, neuronal degeneration and necrosis, perineuronal and perivascular edema in the all regions of the brain and acute neuronal necrosis in the gray matter of ventral horn of the spinal cord were also seen.

Conclusion

Our study suggested that the sheep fetuses are fully susceptible to viral infections and may even develop neurolopathological lesions upon natural infection with mentioned pathogens .Therefore ,according to,specific lesions caused by viral infections, we believe that the histopathological pattern were detected in this study could be associated with either viral infection and or mainly by a Bunyavirus / or Flavivirus strains that extensively shares common lesions with Rift Valley fever ,Wesselsbron ,Cache valley virus / or and Akabaneviruses.

Virtual Slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_223

CIN III Diagnosed following Surgical Termination of Pregnancy

We present a case of a 30-year-old mother of four who was incidentally diagnosed with cervical intraepithelial neoplasia (CIN) III following surgical termination of pregnancy. Five years previously a routine smear test had shown mild dyskaryosis but was never repeated. She was referred to colposcopy and, underwent loop excision of the transformation zone (LLETZ) and subsequently vaginal hysterectomy. Without this incidental finding she would have undoubtedly developed cervical cancer. We discuss the deficiencies in current cervical cancer prevention strategies and termination of pregnancy services. We emphasise the importance of ensuring that patients with dyskaryosis are not lost to follow-up and we consider whether there should be clearer guidance on the value of histological examination of products of conception following termination of pregnancy.

[Gestational trophoblastic disease, Villous gestational trophoblastic disease]

Gestational trophoblastic disease (GTD) represents a wide range of clinical and pathological distinct entities. The villous forms of GTD includes developmental disorders of the placental tree, like blighted ovum, embryonal, partial and complete moles. The risk of persistent GTD is estimated of 2-14% in partial and up to 50% in complete moles. So, the morphologic differentiation between the different entities of villous forms of GTD is clinical very important. Sometimes, early forms of complete moles (up to 12th weeks of gestation) may represent diagnostic problems, even in the diagnosis of regressive alterations of the placental villous tree after intrauterine retention.

Routine follow-up visits after first-trimester induced abortion

Routine follow-up visits after abortion are intended to confirm that the abortion is complete and to diagnose and treat complications. Many clinicians also take advantage of the follow-up visit to provide general reproductive health care: discussing contraceptive plans and providing family planning services; diagnosing sexually transmitted infections; performing a Pap test or discussing abnormal Pap results. We reviewed the evidence related to the routine postabortion follow-up visit. Other than mifepristone medical abortion performed at 50 days of gestation or later and methotrexate medical abortion, we found little evidence that mandatory follow-up visits typically detect conditions that women themselves could not be taught to recognize. In addition, the natural history of the most severe complications after abortion-infection and unrecognized ectopic pregnancy-have time courses inconsistent with the usual timing of the follow-up visit. Costs associated with this visit can be great. These include travel expenses, lost wages, child-care expenses, privacy and emotional burdens for women, and scheduling disruptions and the related opportunity costs caused by "no-shows" for the provider. Follow-up appointments should be scheduled for those women likely to benefit from a physical examination. For the remainder of women, simple instructions and advice about detecting complications, possibly coupled with telephone follow-up, might suffice. Although arguably valuable in their own right, counseling, family planning services, or sexually transmitted infection diagnosis and treatment should not be so inflexibly bundled with postabortion care. Protocols that require in-person follow-up after abortion may not make the best use of a women's time or abilities, or of the medical system.