FACTORS ASSOCIATED WITH CHOOSING FETAL PATHOLOGY EXAMS AFTER SECOND-TRIMESTER DILATION AND EVACUATION

Objectives

In 2023, our hospital transitioned to opt-in fetal pathology examinations to minimize risk of transferring abortion-related information across electronic medical record systems. Our objectives were to describe the proportion of patients opting for fetal examination after dilation and evacuation and report the prevalence of unexpected pathology findings.

Methods

This was a single-institution retrospective chart review of patients who underwent hospital dilation and evacuation for one year before and after changing to opt-in fetal pathology examinations. Inclusion criteria included age ≥18 years, gestational age between 14+0 and 25+6 weeks, and documented pathology exam decision. We assessed the proportion of patients opting for examinations, and associations with demographics and reason for procedure.

Results

We included 78 patients in the before opt-in period and 130 during the opt-in examination period. Demographic characteristics were similar across groups. A minority of patients chose fetal pathology examination during the opt-in period (28.5% full examination, 7.7% limited examination). Rates of opt-in examination varied: 9.7% (undesired pregnancy), 31.8% (maternal health indication), 32.1% (fetal anomaly), and 78.1% (intrauterine fetal demise). There were few unexpected potentially significant pathology findings, most frequently hypocoiled or hypercoiled umbilical cord.

Conclusions

A minority of patients opted for fetal pathology examination after dilation and evacuation. In many cases, the risk of inadvertent abortion disclosure may outweigh the benefit of mandatory examinations, with few potentially significant findings. These findings inform patient counseling at the time of consent for dilation and evacuation. Continued advocacy is needed to increase protections for fetal pathology reports for those patients who benefit from having an examination.