Hysteroscopic morcellation for management of early pregnancy loss: Evaluation of clinical outcomes

Affiliations

Advocate Lutheran General Hospital

Abstract

Study objective: To evaluate clinical outcomes of hysteroscopic morcellation for evacuation of early pregnancy loss including the rate of post-operative intrauterine adhesions, ability to obtain genetic testing results, and explore risk factors associated with procedural complications.

Design: Retrospective chart study.

Setting: Office or operating room.

Participants: 208 patients for early pregnancy loss who underwent hysteroscopic morcellation and subsequent post-operative saline-infused sonohysterogram.

Interventions: Hysteroscopic morcellation, with or without ultrasound guidance, and a saline-infused sonohysterogram ≥ 1 month post-procedure.

Measurements and main results: Post-operative intrauterine adhesion rate, with secondary measures of complication rate and ability to acquire tissue genetic testing. 177 patients completed their post-operative saline-infused sonohysterogram. There were no post-operative intrauterine adhesion findings in exclusively hysteroscopic morcellation cases. In one case that also included dilation and curettage with hysteroscopic morcellation there was an intrauterine adhesion finding, resulting in an overall intrauterine adhesion rate of 0.6% (1/177). The rate of post-operative retained products of conception was 10.7% (19/177). Genetic testing was successfully obtained for 91.3% of cases (189/207), one patient did not want genetic testing performed. Complications occurred in 8.7% (18/208) of cases, the most common complication being fluid overload, 72.2% (13/18), easily treated with furosemide.

Conclusion: This represents the largest reported cohort to date evaluating hysteroscopic morcellation as the primary treatment for the management of early pregnancy loss. Hysteroscopic morcellation is safe and effective for management of early pregnancy loss with a low rate of complications and intrauterine adhesions post-operatively.

Type

Article

PubMed ID

41662904

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