Abstract
Determine if hysteroscopic morcellation is a safe and effective method to evacuate products of conception after a missed abortion. Retrospective review of prospectively maintained database of women who experienced a missed abortion (<12 weeks) and underwent hysteroscopic morcellation procedure to evacuate products of conception from May 2019 through February 2021. Forty-five (45) patients underwent hysteroscopic morcellation. The mean age was 35.6 years (range 26- 48 years), with mean gravida and parity of 2.09 (range 1- 8) and 0.57 (range 0-6), respectively. Sixty two percent (28/45) were performed in the office under sedation, while 17/45 (37.8%) were performed in OR. The mean gestational age was 8 1/7 days (range 5- 11 weeks) with a mean B-hcg of 31,311 (range 1100-149,983). The majority of patients 31/45 (68.9%) had never undergone an intra-uterine procedure, 6/45 (13.3%) had a previous suction D&C, 6/45 (13.3%) had a previous diagnostic hysteroscopy, and 9% had a previous operative hysteroscopy (including 2 patients with more than 1 procedure). Only 3/45 (6.6%) experienced a complication during the procedure and none experienced a post-operative complication. All complications were due to excess fluid absorption (two were given intravenous diuretics and one recovered without intervention). In terms of chromosomal analysis, 21/45 (46.7%) had a normal karyotype, 18/45 (40%) had an abnormal karyotype, and 6/45 (13.3%) had no growth of chromosomes. Finally, 35/45 (77%) of patients had a normal SIS within 3 months of the procedure, 8/45 (17.7%) did not undergo SIS, but 3/8 were subsequently pregnant, and 2/45 (4.4%) had abnormal findings on SIS. One underwent a hysteroscopy and an endometrial polyp was removed, and the second underwent diagnostic hysteroscopy for retained products, but the hysteroscopy was normal. Hysteroscopic morcellation is safe for treating first trimester miscarriages with a low complication rate, strong ability to evaluate the tissue for chromosomal analysis, and no evidence of intrauterine adhesions post-operatively.
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