Management of first trimester pregnancy termination failures.

Suction curettage is the procedure of choice for first trimester abortion. The basic preevaluation and follow-up standards for this operation have been adopted by most physicians. In some instances, however, follow-up assessment may be inadequate, particularly regarding the histopathologic evaluation of uterine contents. As a result, recognition of serious conditions such as ectopic pregnancy may be delayed. When a first trimester abortion fails, when scanty tissue is obtained, or when histopathologic examination demonstrates only decidual tissue, an extrauterine pregnancy or pregnancy in an anomalous uterus must be considered. Ultrasonography and endoscopic methods such as laparoscopy and hysteroscopy are invaluable in locating the site of the pregnancy and in preventing serious sequelae. The authors report the outcome of 25 women in whom abortion by suction curettage failed. A protocol outlining the methods used for diagnosis and therapeutic management is presented.