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Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

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).

Design

Prospective single-arm cohort study.

Setting

University-affiliated Department of Obstetrics and Gynecology.

Patients

Women admitted for surgical evacuation of early pregnancy loss were invited to participate in the study.

Intervention

Vaginal misoprostol was administered for cervical ripening preoperatively. Under general anesthesia, a diagnostic hysteroscopy was performed to identify the pregnancy’s implantation wall, followed by ultrasound-guided suction and curettage directed to the implantation wall, and then diagnostic hysteroscopy to verify complete uterine cavity emptying. Postoperative IUA were evaluated by follow-up office hysteroscopy.

Main Outcome Measure

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-related restrictions on elective procedures.

Results

Forty patients were included in the study group. Their mean age was 34.0 ± 6.6 years, and their mean gestational age was 8.9 ± 1.6 weeks. The implantation wall was clearly visualized on hysteroscopy in 33 out of 40 cases (82.5%). The mean operative time was 17.2 ± 8.8 min, and no intraoperative complications occurred. Suspected RPOC were diagnosed intraoperatively by hysteroscopy and removed in 4 cases, and the histologic examination confirmed the presence of RPOC in three of them. Follow-up office hysteroscopy was performed in nine women: mild IUA was diagnosed in one case and a normal cavity was confirmed in eight cases. A new pregnancy was reported at the time of follow-up in 15 cases, while 12 women declined to attend the follow-up hysteroscopy and four were lost to follow-up.

Conclusions

Hysteroscopy-assisted suction curettage for early pregnancy loss is a safe, short, and inexpensive procedure, which allows the identification of the pregnancy’s wall in most cases and may reduce the rates of RPOC.

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Data availability

Data supporting this study are included within the article and/or supporting materials.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Yitzhak Shamir (Formerly Assaf Harofeh) Medical Center, Zerifin, Israel

    Omer Moore, Tamar Tzur, Zvi Vaknin, Moran Landau Rabbi & Noam Smorgick

  2. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Omer Moore, Tamar Tzur, Zvi Vaknin, Moran Landau Rabbi & Noam Smorgick

  3. Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, 70300, Zeriffin, Beer Yaakov, Israel

    Omer Moore

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  1. Omer Moore
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  2. Tamar Tzur
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  3. Zvi Vaknin
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  4. Moran Landau Rabbi
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  5. Noam Smorgick
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Contributions

OM: project development, data analysis, manuscript writing. TT: data analysis, manuscript writing. ZV: project development, data analysis. MR: data analysis. NS: project development, data analysis, manuscript writing.

Corresponding author

Correspondence to Omer Moore.

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Moore, O., Tzur, T., Vaknin, Z. et al. Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?. Arch Gynecol Obstet 309, 205–210 (2024). https://doi.org/10.1007/s00404-023-07238-8

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  • DOI: https://doi.org/10.1007/s00404-023-07238-8

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