Hystero-Embryoscopy: Evaluation and Evacuation of Spontaneous Missed Abortions

Abstract

<h3>Study Objective</h3> To demonstrate the steps for hystero-embryoscopic evaluation of a 7-week spontaneous missed abortion and evacuation of the products of conception. Illustrate the surgical technique and highlight its advantages in improving the evaluation of spontaneous missed abortions. <h3>Design</h3> Video case presentation and demonstration of surgical technique. <h3>Setting</h3> Video-hysteroscopy. <h3>Patients or Participants</h3> Patient provided consent for the video and publication. <h3>Interventions</h3> Following vaginoscopy, the cervix is approached without prior blind cervical dilation. Using a 2.9 mm diameter hysteroscope, navigation from the endocervix to the endometrial cavity is performed. The endometrial cavity is thoroughly inspected revealing an intact gestational sac and submucosal fibroids. The operative grasper is introduced, the chorion and amnion are penetrated and embryoscopy is performed. In-flow in reduced for external morphological inspection of the embryo; it is then grasped and retrieved. The procedure is continued by introducing of a 26-french bipolar resectoscope. The product of conception are excised without electricity and sent for histologic and genetic studies. <h3>Measurements and Main Results</h3> Cytogenic analysis for this case revealed a female embryo with trisomy 15. No maternal and fetal cell admixture was noted in the analysis, allowing a precise diagnosis. <h3>Conclusion</h3> Hystero-embryoscopy is a valuable diagnostic and therapeutic procedure for cases of missed abortion. It may reveal embryonic morphological abnormalities, expand the diagnostic spectrum in the evaluation of pregnancy loss and avoid potential complications from blind curettage.