Ultrasonographic features of the endometrium following successful medical termination of early pregnancy. (January 2023)

• Record Type: Journal Article
• Authors: Kücükyildiz, Asli Sena; Berner-Hansen, Victoria; Nguyen, Henriette; Nguyen, Tri; Meaidi, Amani
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 280(2023)
• Page Start: 102
• Page End: 107
• Publication Date: 2023-01
• Subjects: Abortion -- Endometrium -- Induced abortion -- Medical abortion -- Ultrasonography; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2022.11.018
• Languages: English
• ISSNs: 0301-2115

Abstract

Highlights: Endometrial thickness and echogenicity vary considerably following successful early medical abortion. All possible patterns of change in endometrial thickness and echogenicity may be observed in the weeks following induction. Endometrial features should be considered with caution in the decision of surgical intervention of early medical abortion. Abstract: Objective: Ultrasonographic features of the endometrium are often assessed when deciding the necessity of surgical intervention following early medical abortion. Knowledge is therefore needed on the ultrasonographic appearance of the endometrium following successful medical abortion in order to avoid unnecessary surgical interventions. We aimed to assess endometrial thickness and echogenicity at multiple time points following successful early medical abortion. Study design: We conducted a retrospective study in the largest office-based abortion providing clinic in Denmark. Using archived ultrasonographic images, we assessed endometrial thickness and echogenicity following all early medical abortions that did not need surgical intervention or repeated medication for completion during the years 2014–2017. Results: Ultrasonographic endometrial features were assessed 1854 times following 1074 early medical abortions. Median endometrial thickness in the 1st week from induction was 13 milimeters (mm; lower-upper quartile 11–17 mm). For the 2nd, 3rd, 4th, and >4th week, the median endometrial thickness was found to be 11 mm (9–15 mm), 11 mm (8–14 mm), 12 mm (9–16 mm), and 11 mm (8–14 mm), respectively. Of the ultrasonographic examinations performed in the 1st week from medical induction, 24.7 % showed a heterogenous endometrium. For 2nd, 3rd, 4th, >4th week, the frequency of heterogeneity was 23.9 %, 16.3 %, 21.3 %, 18.9 %, respectively. A total of 151 abortions (14.1 %) were each examined three times, median time of examination being day 7, 15, and 26 following induction. Among these abortions, the three most common patterns of change in endometrial thickness were "decreasing" (37.7 %), "increasing-decreasing" (23.2 %), and "decreasing-increasing" (21.9 %). Further, 49.7 % of the 151 abortions showed a homogenous endometrium at all three examinations, 17.2 % showed a heterogenous endometrium at first examination and a homogenous endometrium the following two examinations, and 9.9 % showed a heterogenous endometrium at the first two examinations followed by a homogenous endometrium. Conclusion: In early medical abortions completed without secondary intervention, endometrial thickness and echogenicity varied clinically significantly for weeks following the medical induction. Every possible pattern of change in endometrial thickness and echogenicity was observed.