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

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 in cases of early pregnancy loss were offered participation 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 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 and restrictions on elective procedures. Results: 40 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. In 33 out of 40 cases (82.5%), the implantation wall was clearly visualized on hysteroscopy. The mean operative time was 17.2 ± 8.8 minutes, and no intraoperative complications occurred. In 4 cases, suspected RPOC were diagnosed intraoperatively by hysteroscopy and removed. The histology examination confirmed the presence of RPOC in 3 out of these 4 suspected RPOC cases. Follow-up office hysteroscopy was performed in 9 women, diagnosing mild IUA in one case and a normal cavity in 8 cases. In 15 cases, a new pregnancy was reported at time of follow-up, while 12 women declined to attend the follow up-hysteroscopy and 4 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 and IUA.