Comparing preoperative dating and postoperative dating for second-trimester surgical abortions

Sameera Mokkarala, Mitchell D Creinin, Machelle D. Wilson, Nicole S. Yee, Melody Hou

Research output: Contribution to journalArticle

Abstract

Objectives: To assess relationships between preoperative and postoperative dating of second-trimester surgical abortion. Study design: We used a deidentified institutional database to extract demographic, dating and pathology data for surgical abortions performed at 14 to 23-6/7 weeks’ gestational age (GA) from 9/2015 to 5/2017. We excluded women with multiple gestations, fetal anomalies and missing fetal biometric measurements. We assigned preoperative GA by ultrasonography for unknown last menstrual period (LMP) or when discrepancy between sonographic and LMP dating exceeded 7 days (<15-6/7 weeks), 10 days (16 to 21-6/7 weeks) or 14 days (22 to 23-6/7 weeks). We determined postoperative GA using fetal foot length pathology standards published by Streeter in 1920 and Drey et al. in 2005. We performed regression analysis to estimate the relationship between pre- and postoperative estimates of GA and to assess demographic effects on these estimates, and χ2 tests to assess whether fetal foot lengths were concordant with, larger than or smaller than the expected range for the preoperative GA. Results: The 469 patients analyzed had a median preoperative GA of 19-4/7 weeks (range 14-0/7 to 23-6/7 weeks). Preoperative dating highly correlated with postoperative dating using both pathology standards (r2=0.95, p<.001), without any clinically relevant effect by body mass index (Streeter and Drey, p=.79), parity (Streeter p=.89; Drey p=.71), race (Streeter p=.06; Drey p=.07) or GA. Fetal foot lengths were larger than expected in 134 (28.6%) women using Streeter and 17 (3.6%) women using Drey standards (p<.001). Conclusions: Preoperative dating and postoperative dating for second-trimester surgical abortion highly correlate. Use of Streeter standards results in more women with a postoperative GA greater than expected compared to Drey standards. Implications: Increasing legal gestational age restrictions have placed additional burden on clinicians providing safe abortions, but guidelines on gestational age determination are lacking. Contemporary pathology standards consistent with modern practice and universally accepted by abortion providers and gynecologic pathologists are critical to our goal of safe and legal abortion provision.

Original languageEnglish (US)
JournalContraception
DOIs
StatePublished - Jan 1 2019

Fingerprint

Second Pregnancy Trimester
Gestational Age
Foot
Pathology
Demography
Legal Abortion
Surgical Pathology
Parity
Ultrasonography
Body Mass Index
Regression Analysis
Databases
Guidelines
Pregnancy

Keywords

  • Abortion
  • Fetal foot length
  • Gestational age
  • Postnatal foot length
  • Pregnancy
  • Ultrasound

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Comparing preoperative dating and postoperative dating for second-trimester surgical abortions. / Mokkarala, Sameera; Creinin, Mitchell D; Wilson, Machelle D.; Yee, Nicole S.; Hou, Melody.

In: Contraception, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Objectives: To assess relationships between preoperative and postoperative dating of second-trimester surgical abortion. Study design: We used a deidentified institutional database to extract demographic, dating and pathology data for surgical abortions performed at 14 to 23-6/7 weeks’ gestational age (GA) from 9/2015 to 5/2017. We excluded women with multiple gestations, fetal anomalies and missing fetal biometric measurements. We assigned preoperative GA by ultrasonography for unknown last menstrual period (LMP) or when discrepancy between sonographic and LMP dating exceeded 7 days (<15-6/7 weeks), 10 days (16 to 21-6/7 weeks) or 14 days (22 to 23-6/7 weeks). We determined postoperative GA using fetal foot length pathology standards published by Streeter in 1920 and Drey et al. in 2005. We performed regression analysis to estimate the relationship between pre- and postoperative estimates of GA and to assess demographic effects on these estimates, and χ2 tests to assess whether fetal foot lengths were concordant with, larger than or smaller than the expected range for the preoperative GA. Results: The 469 patients analyzed had a median preoperative GA of 19-4/7 weeks (range 14-0/7 to 23-6/7 weeks). Preoperative dating highly correlated with postoperative dating using both pathology standards (r2=0.95, p<.001), without any clinically relevant effect by body mass index (Streeter and Drey, p=.79), parity (Streeter p=.89; Drey p=.71), race (Streeter p=.06; Drey p=.07) or GA. Fetal foot lengths were larger than expected in 134 (28.6{\%}) women using Streeter and 17 (3.6{\%}) women using Drey standards (p<.001). Conclusions: Preoperative dating and postoperative dating for second-trimester surgical abortion highly correlate. Use of Streeter standards results in more women with a postoperative GA greater than expected compared to Drey standards. Implications: Increasing legal gestational age restrictions have placed additional burden on clinicians providing safe abortions, but guidelines on gestational age determination are lacking. Contemporary pathology standards consistent with modern practice and universally accepted by abortion providers and gynecologic pathologists are critical to our goal of safe and legal abortion provision.",
keywords = "Abortion, Fetal foot length, Gestational age, Postnatal foot length, Pregnancy, Ultrasound",
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AU - Hou, Melody

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N2 - Objectives: To assess relationships between preoperative and postoperative dating of second-trimester surgical abortion. Study design: We used a deidentified institutional database to extract demographic, dating and pathology data for surgical abortions performed at 14 to 23-6/7 weeks’ gestational age (GA) from 9/2015 to 5/2017. We excluded women with multiple gestations, fetal anomalies and missing fetal biometric measurements. We assigned preoperative GA by ultrasonography for unknown last menstrual period (LMP) or when discrepancy between sonographic and LMP dating exceeded 7 days (<15-6/7 weeks), 10 days (16 to 21-6/7 weeks) or 14 days (22 to 23-6/7 weeks). We determined postoperative GA using fetal foot length pathology standards published by Streeter in 1920 and Drey et al. in 2005. We performed regression analysis to estimate the relationship between pre- and postoperative estimates of GA and to assess demographic effects on these estimates, and χ2 tests to assess whether fetal foot lengths were concordant with, larger than or smaller than the expected range for the preoperative GA. Results: The 469 patients analyzed had a median preoperative GA of 19-4/7 weeks (range 14-0/7 to 23-6/7 weeks). Preoperative dating highly correlated with postoperative dating using both pathology standards (r2=0.95, p<.001), without any clinically relevant effect by body mass index (Streeter and Drey, p=.79), parity (Streeter p=.89; Drey p=.71), race (Streeter p=.06; Drey p=.07) or GA. Fetal foot lengths were larger than expected in 134 (28.6%) women using Streeter and 17 (3.6%) women using Drey standards (p<.001). Conclusions: Preoperative dating and postoperative dating for second-trimester surgical abortion highly correlate. Use of Streeter standards results in more women with a postoperative GA greater than expected compared to Drey standards. Implications: Increasing legal gestational age restrictions have placed additional burden on clinicians providing safe abortions, but guidelines on gestational age determination are lacking. Contemporary pathology standards consistent with modern practice and universally accepted by abortion providers and gynecologic pathologists are critical to our goal of safe and legal abortion provision.

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