The safety of hysteroscopy in miscarriage can be inferred from the extensive literature on hysteroscopic management used for the treatment of retained products of conception (RPOC). A recent systemic review and meta-analysis comprising 20 studies and 2000 patients cited a rate of 91% of complete resection after one procedure and a rate of 0.07% of post-surgical intrauterine adhesions.3 There was a complication rate of 2% which included perforation, fluid overload, fever and hemorrhage.
There are a few retrospective reports of hysteroscopy as the primary treatment for early miscarriages. by Codt et al. presented a retrospective cohort study comparing results in patients who underwent primary hysteroscopic management of early miscarriage with D&C or hysteroscopy with cold loop resectoscope.2 Complications, including cervical lacerations, perforations uterine and endometritis were rare in both treatment groups. Bleeding, defined as blood loss of more than 500 ml, occurred in two cases in the D&C group.
When considering the primary hysteroscopic management of an early miscarriage, one proposed advantage is the potential for site-directed biopsy of the tissue. Cholkeri-Singh, Zamfirova, and Miller compared fetal tissue samples from early miscarriage patients who underwent D&C alone to those undergoing a directed biopsy under hysteroscopic visualization followed by D&C. Hysteroscopic-directed fetal tissue biopsy significantly reduced the rate of maternal contamination of specimens.4 Although this method of biopsy may provide patients with additional information to guide the management of future pregnancies, this fetal genetic test may not be appropriate. than in a small subset of these patients.
Primary hysteroscopic management of early miscarriages has possible benefits, including a high rate of complete ablation in one procedure, the ability to perform a targeted tissue biopsy, and the potential to reduce intra-adhesion formation. uterine while probably not significantly increasing the risk of perioperative complications. The limitations include the potentially higher cost and the necessary surgical resources and expertise. Prospective studies are needed to assess complications, costs and patient satisfaction. Surgical management of early miscarriages is an important option for women and reporting new innovative techniques is a core mission of JMIG. We look forward to future prospective studies to explore and confirm the value and role of this approach… or show that it is a well-intentioned but temporary fad!
Hooker AB, Lemmers M, Thurkow AL, et al. Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, risk factors and long-term reproductive outcomes. Hum Reprod Update. 2014; 20 (2): 262-278. doi: 10.1093 / humupd / dmt045
by Codt M, Balza C, Jadoul P, et al. Hysteroscopic resection for missed abortion: feasibility, operative technique and potential benefit compared to curettage. Surg before. 2020; 7: 64. doi: 10.3389 / fsurg.2020.00064
Vitale SG, Parry JP, Carugno J, et al. Surgical and reproductive outcomes after hysteroscopic ablation of retained conception products: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2021; 28 (2): 204-217. doi: 10.1016 / j.jmig.200.10.028
Cholkeri-Singh A, Zamfirova I, Miller CE. Increased detection of fetal chromosomes through the use of operative hysteroscopy during evacuation of products of conception for a diagnosed miscarriage. J Minim Invasive Gynecol. 2020; 27 (1): 160-165. doi: 10.1016 / j.jmig.2019.03.014
Weinberg S, Pansky M, Burshtein I, Beller U, Goldstein H, Barel O. A pilot study on guided conservative hysteroscopic evacuation of early miscarriages. J Minim Invasive Gynecol. 2021; XXX (XXX); XXX. doi: 10.1016 / j.jmig.2021.04.017
Accepted: September 15, 2021
Received: September 14, 2021
In the Pre-Proof newspaper
No conflict of interest to declare
© 2021 Posted by Elsevier Inc. on behalf of AAGL.