A Pilot Study of Guided Conservative Hysteroscopic Evacuation of Early Miscarriage

Abstract

<h3>Study Objective</h3> To evaluate initial feasibility and experience with guided hysteroscopic morcellation of uterine evacuation of early miscarriage. <h3>Design</h3> Prospective pilot study in a tertiary University hospital in Israel from May to October 2020. <h3>Setting</h3> Procedures were done under general anesthesia in the operating room. <h3>Patients or Participants</h3> Ten women with confirmed early miscarriage at gestational age of under 10 weeks from the last menstrual period. <h3>Interventions</h3> Hysteroscopic TRUCLEAR® tissue removal system was used for evacuation of early miscarriage. Procedures were done under ultrasound guidance. The procedures were recorded. (video). Data including the length of the procedure, visibility, complete evacuation, bleeding, complications, and follow-up ultrasound were documented. Patient consent to present and publish has been obtained. <h3>Measurements and Main Results</h3> Complete evacuation was recorded inall cases. No adverse events were recorded in any of the ten procedures. Mean time of the procedure was 24 minutes. In four cases (40%) an additional suction curettage was performed after the hysteroscopic procedure due to obscured visibility or abnormal ultrasound scan at the end of the procedure. However, RPOC were found in only one case (10%) in the suction specimen. Normal uterine cavity without evidence of retained products of conception (RPOC) was documented in follow-up evaluation by ultrasound in all cases, four patients underwent a diagnostic office hysteroscopy that demonstrated a normal cavity without evidence of adhesions. <h3>Conclusion</h3> Under vision Hysteroscopic morcellation seems to be a safe and feasible technique for management early miscarriage. This method may have a potential as an innovative treatment of miscarriage in selected cases. Further studies are needed to refine the indications and the surgical technique.