2860 Diagnostic Hysteroscopy in Missed Abortion

Abstract

Video Objective To present two surgical cases of diagnostic hysteroscopy at the time of uterine evacuation for spontaneous abortion and to review the literature on hysteroscopy use in the setting of spontaneous abortion. Setting One 37-year-old G4P1021 at 9 weeks 1-day gestation with spontaneous abortion and a history of uterine septum status post prior septal resection, who desired surgical management with uterine evacuation. The second case is a 38-year-old G5P2022 at 9 weeks gestation with spontaneous abortion and a history of recurrent pregnancy loss who desired surgical management with uterine evacuation. Both patients underwent uncomplicated diagnostic hysteroscopy and suction curettage at an academic medical center. Interventions In this surgical video, we present two cases of women with first trimester spontaneous abortion who desired surgical management with uterine evacuation. Both cases had preoperative indications for uterine cavity inspection with hysteroscopy given their histories of a uterine anomaly and recurrent pregnancy loss. Diagnostic hysteroscopy was performed in both cases prior to the suction dilation and curettage procedures to closely inspect the cavities as well as identify the implantation site for site-specific curettage as compared to the traditional global suction curettage. Additionally, we summarize the current literature on hysteroscopy use in the setting of spontaneous abortion. Conclusion Diagnostic hysteroscopy at the time of uterine evacuation for patients with spontaneous abortion is a feasible alternative to traditional suction curettage alone and can provide additional clinical information regarding implantation site for directed resection as well as uterine cavity inspection for uterine anomalies or alternative pathology.