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Routine Pathology for Intrauterine Devices and Therapeutic Abortion: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Last updated: September 12, 2019
Project Number: RC1176-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical utility of routine pathology for removed intrauterine devices?
  2. What is the clinical utility of routine pathology for therapeutic abortions?
  3. What is the cost-effectiveness of routine pathology for removed intrauterine devices?
  4. What is the cost-effectiveness of routine pathology for therapeutic abortions?
  5. What are the evidence-based guidelines regarding routine pathology for intrauterine devices or therapeutic abortions?

Key Message

Evidence from one non-randomized study with several key limitations suggested that both surgeons and pathologists were poor at predicting abnormal outcomes following therapeutic abortion at less than six weeks gestation. The agreement between assessments performed by surgeons and pathologists was poor. Evidence-based guidelines from the Society of Obstetricians and Gynaecololgists of Canada strongly recommend histopathological examination of products of conception when gestational trophoblastic neoplasia or ectopic pregnancy is suspected. However, this is a general recommendation; no recommendation was provided specific to therapeutic abortion unrelated to fetal abnormalities or medical concerns, which was the population of interest to this report. Guidelines from the National Abortion Federation state that additional pathological examination of evacuated uterine contents is not required. No evidence of the clinical utility of routine pathology for removed intrauterine devices, cost-effectiveness of routine pathology for therapeutic abortions or removed intrauterine devices, or evidence-based guidelines regarding routine pathology for intrauterine devices was identified.