Hysteroscopy Assisted Suction Curettage for Early Miscarriage: Does It Reduce Rpocn and Postoperative Intrauterine Adhesions?

Abstract

<h3>Study Objective</h3> To describe the feasibility of hysteroscopy assisted suction curettage for early pregnancy loss and to investigate whether it reduces the rates of retained products of conception (RPOC) and intrauterine adhesions (IUA). <h3>Design</h3> Prospective single-arm cohort study. <h3>Setting</h3> University-affiliated department of Obstetrics and Gynecology. <h3>Patients or Participants</h3> Women admitted for surgical evacuation in cases of early pregnancy loss. <h3>Interventions</h3> Vaginal misoprostol was administered for cervical ripening preoperatively. Under general anesthesia, hysteroscopy was performed to identify the pregnancy's implantation wall, followed by ultrasound-guided suction and curettage directed to the implantation wall, and hysteroscopy to verify uterine cavity emptying. Postoperative IUA were evaluated by follow-up hysteroscopy. <h3>Measurements and Main Results</h3> Identification of the pregnancy's implantation wall on hysteroscopy, and intra- and postoperative complications associated with the procedure. The evaluation of postoperative IUA was limited due to the COVID-19 pandemic restrictions. Main Results: 40 patients, with early pregnancy loss were studied. In 33 out of 40 cases (82.5%), the implantation wall was clearly visualized on hysteroscopy. In 4 cases, suspected RPOC were diagnosed intraoperatively by hysteroscopy and removed. The histology examination confirmed the presence of RPOC in 3 out of 4 cases. Follow-up office hysteroscopy was performed in 9 women, diagnosing mild IUA in one out of 9 cases. In 15 cases, a new pregnancy was reported at time of follow-up. <h3>Conclusion</h3> Hysteroscopy assisted suction curettage for early pregnancy loss is safe procedure, which allows the identification of the pregnancy's implantation wall in most cases and may reduce the rates of RPOC and IUA. By identification of uterine anomalies, the procedure may offer a potential benefit in terms of reproductive outcomes for hypo-fertile patients.