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Incidence of intrauterine adhesion after ultrasound-guided manual vacuum aspiration (USG-MVA) for first-trimester miscarriages: a prospective cohort study

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Ultrasound-guided manual vacuum aspiration (USG-MVA) is a feasible and effective outpatient treatment to treat early pregnancy loss.

Methods

This was a prospective observational study at a university-affiliated hospital. All women undergoing either a USG-MVA or electric vacuum aspiration (EVA) were invited to return 3–6 months later for follow-up at which women completed a questionnaire to document their post-evacuation menstrual and reproductive history, and underwent a hysteroscopy if they were not pregnant. The severity of intrauterine adhesion (IUA), if present, was graded (Stage I-III) according to the American fertility society classification.

Results

A total of 292 women had a hysteroscopy after their initial surgical evacuation, USG-MVA 169(57.9%) versus EVA 123(42.1%). Women undergoing EVA as opposed to a USG-MVA had a 12.9% higher incidence of IUA (24.1% vs. 37.0%, p = 0.042) equivalent to 1.84 times higher risk (95% CI 1.01–3.34; p = 0.048). Women having EVA continued to show an increased but not statistically significant trend towards an increased risk of IUA after adjusting for the type of miscarriage (aOR = 1.3; 95% CI 0.66–2.50; p = 0.46).

Conclusion

There were no significant differences in their reproductive outcomes and fewer women post-USG-MVA complained of hypomenorrhea. IUA may still occur in women undergoing USG-MVA but it is lower than the rate in women undergoing EVA.

Clinical trials registry The trial was registered with the Centre for Clinical Research and Biostatistics – Clinical Trials Registry (CCRBCTR), a partner registry of the WHO Primary Registry-Chinese Clinical Trials Registry (ChiCTR) with a Unique Trial Number: CUHK_CCRB00541 on 22 Dec 2016.

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Data availability

Some or all datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank all the women who have participated in this study as well as Ms. Lee Wing Ki Cheryl and Ms. Chung Mei Lan Tiffany for their assistance in recruiting women and data entry.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, 1/F, Block E, Special Block, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR, China

    Jacqueline Pui Wah Chung, Olivia See Yung Chau, Tracy Sze Man Law, Karen Ng, Patricia Nga Ping Ip, Elaine Yee Lee Ng, Tracy Kwan Yi Tso, Daljit Singh Sahota & Tin Chiu Li

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  1. Jacqueline Pui Wah Chung
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Contributions

JPWC: Conceptualization, Methodology, Investigation, Writing - Original Draft, Supervision, Writing - Review & Editing. OSYC: Investigation, Writing - Original Draft. TSML: Investigation. KN: Investigation. PNPI: Investigation. EYLN: Data Curation, Visualization, Writing - Original Draft. TKYT: Data Curation, Visualization, Writing - Original Draft. DSS: Data Curation, Visualization, Writing - Original Draft. TCL: Supervision, Writing - Review & Editing.

Corresponding author

Correspondence to Jacqueline Pui Wah Chung.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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The participant has consented to the submission of the case report to the journal.

Ethical approval

This is an observational study. The study was approved by the Institutional Review Board of our institution (Joint Chinese University of Hong Kong- New Territories East Cluster Clinical Research Ethics Committee registration number CREC-2016.457).

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Chung, J.P.W., Chau, O.S.Y., Law, T.S.M. et al. Incidence of intrauterine adhesion after ultrasound-guided manual vacuum aspiration (USG-MVA) for first-trimester miscarriages: a prospective cohort study. Arch Gynecol Obstet 309, 669–678 (2024). https://doi.org/10.1007/s00404-023-07280-6

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