Hysteroscopic Resection of Early Pregnancy Loss

Abstract

<h3>Study Objective</h3> 1. To report a case of early pregnancy loss successfully managed by hysteroscopic resection; 2. To review the literature comparing hysteroscopic resection to dilation and curettage for retained products of conception; and 3. To review potential advantages of hysteroscopic resection over dilation and curettage for management of early pregnancy loss. <h3>Design</h3> Case Report. <h3>Setting</h3> Academic affiliated private practice. <h3>Patients or Participants</h3> One woman with early pregnancy loss. <h3>Interventions</h3> Hysteroscopic resection using a mechanical morcellation device. <h3>Measurements and Main Results</h3> Complete uterine evacuation as demonstrated by normal transvaginal ultrasound and cessation of bleeding two weeks postoperatively after hysteroscopic resection. Hysteroscopic fluid deficit was 365ml with minimal blood loss. Products of conception were confirmed on pathologic examination. There were no intraoperative or postoperative complications. Saline infusion sonogram four months postoperatively demonstrated a normal endometrial cavity with no intrauterine adhesions. <h3>Conclusion</h3> Surgical management of early pregnancy loss may be complicated by retained products of conception (RPOC) or intrauterine adhesion formation (IUA), which can lead to adverse future fertility outcomes. Hysteroscopic resection has been associated with less intrauterine adhesions, more complete tissue removal, and earlier time to conception compared to dilation and curettage (D&C) in cases of retained products of conception. Early pregnancy loss can also be characterized as retained products of conception with potentially similar benefits from hysteroscopic resection. Thus, hysteroscopic resection can be considered an alternative surgical technique for management of early pregnancy loss. This case report demonstrates the successful application of hysteroscopic resection in a case of early pregnancy loss.