Download Absence of chorionic villi in products of conception

WOMEN AND NEWBORN HEALTH SERVICE
King Edward Memorial Hospital
CLINICAL GUIDELINES
GYNAECOLOGY GUIDELINES
ABNORMALITIES OF EARLY
PREGNANCY
Date Issued: 2001
Date Revised: January 2014
Review Date: January 2017
Authorised by: OGCCU
Review Team: OGCCU
Absence of chorionic villi in products of conception & Negative laparoscopy
Section C
Clinical Guidelines
King Edward Memorial Hospital
Perth Western Australia
ABSENCE OF CHORIONIC VILLI IN PRODUCTS OF
CONCEPTION & NEGATIVE LAPAROSCOPY
BACKGROUND
Confirmation of pregnancy through histological examination following miscarriage and surgical
evacuation of the uterus is recommended in the rare instance that an ectopic pregnancy or molar
pregnancy continues. The risk of ectopic pregnancy diagnosed following surgical treatment for
1
miscarriage was found to be 0.42% . When treating ectopic pregnancy by surgical management failure
2, 3
rates are significantly higher when a salpingostomy is performed . The failure rate is reported to be
3
between 5-20% with this procedure .
KEY POINTS
•
ßHCG levels should fall following removal of all trophoblastic tissue.
•
If histology of the products of conception does not demonstrate chorionic villi, ectopic
pregnancy must be excluded.
In the absence of chorionic villi in products of conception:
Refer to Clinical Guideline Diagnosis of Ectopic Pregnancy.
NEGATIVE LAPAROSCOPY
Rarer forms of ectopic pregnancy such as interstitial/corneal implantations can be missed at
laparoscopy. Tubal abortion is another cause of a negative laparoscopy.
MANAGEMENT
1. The woman must be contacted and if pain is present, prompt medical review should occur.
2. Serial quantitative ßHCG measurements should be performed weekly to determine demise or
4
continuation of the pregnancy .

DPMS
Ref: 8469
A plateau or rise in ßHCG level >5% signifies a persistent ectopic; ßHCG <5% of
preoperative value indicates resolution of ectopic pregnancy. ßHCG should continue
5
until the level is <15IU/L. At this level all ectopic pregnancy resolves without rupture .
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
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3. If the ßHCG rises further USS should be performed when the level reaches 1500IU/l or if pain
4
develops (an intrauterine pregnancy should be identified by transvaginal ultrasound when is >1500
IU/l ßHCG).
4. The woman should be warned of the risks of on-going ectopic pregnancy and the need for closely
monitored follow-up. If pain develops the woman should be advised to seek medical attention
urgently.
For treatment options refer to the following Clinical Guidelines:
Medical Management of Ectopic Pregnancy using Methotrexate
Expectant Management of Ectopic Pregnancy
Surgical Management of Ectopic Pregnancy
REFERENCES
1.
2.
3.
4.
5.
Royal College of Obstetricians and Gynaecologists. The Management of Early Pregnancy
Loss, . Green-top Guideline No 25. 2006:1-18.
Royal College of Obtetricians and Gynaecologists. The management of tubal pregnancy
2010; Available from: http://www.rcog.org.uk/files/rcog-corp/GTG21_230611.pdf.
Vichnin. M. Ectopic pregnancy in adolescents. Current Opinion in Obstetrics and
Gynacology. 2008;20:475-8.
Visconti K., Zite N. hCG in Ectopic Pregnancy. Clinical Obstetrics & Gynecology.
2012;55(2):410-7.
Murray. H., Baakdah. H., Bardell. T., Tulandi. T. Diagnosis and treatment of ectopic pregnancy
Canadian Medical Association Journal 2005;173(8):905-12.
Date Issued: 2001
Date Revised: January 2014
Review Date: January 2017
Written by:/Authorised by: OGCCU
Review Team: OGCCU
DPMS Ref: 8469
Absence of chorionic villi in products of conception & Negative laparoscopy
Section Gynaecology
Clinical Guidelines
King Edward Memorial Hospital
Perth Western Australia
All guidelines should be read in conjunction with the Disclaimer at the beginning of this section
Page 2 of 2