Hysteroscopic resection for management of early pregnancy loss: a case report and literature review

Young, Stacy; Miller, Charles E.

doi:10.1016/j.xfre.2022.03.002

Cited by 2 publications

(2 citation statements)

References 30 publications

(44 reference statements)

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“…Recent studies have demonstrated hysteroscopic resection to be effective in surgically evacuating the uterus for initial treatment after EPL. [7][8][9][10] Because our physicians surgically treat EPL with suction D&C, further research is needed to determine whether directed hysteroscopic resection decreases the incidence of retained products of conception after surgical management.…”

Section: Discussionmentioning

confidence: 99%

Utility of Office Hysteroscopy in Diagnosing Retained Products of Conception Following Early Pregnancy Loss After In Vitro Fertilization

George,

Naert,

Lanes

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate the utility of office hysteroscopy in diagnosing and treating retained products of conception in patients with infertility who experience early pregnancy loss (EPL) after in vitro fertilization (IVF). METHODS: We evaluated a retrospective cohort of 597 pregnancies that ended in EPL in patients aged 18–45 years who conceived through fresh or frozen embryo transfer at an academic fertility practice between January 2016 and December 2021. All patients underwent office hysteroscopy after expectant, medical, or surgical management of the EPL. The primary outcome was presence of retained products of conception at the time of office hysteroscopy. Secondary outcomes included incidence of vaginal bleeding, presence of intrauterine adhesions, treatment for retained products of conception, and duration of time from EPL diagnosis to resolution. Log-binomial regression and Poisson regression were performed, adjusting for potential confounders including oocyte age, patient age, body mass index, prior EPL count, number of prior dilation and curettage procedures, leiomyomas, uterine anomalies, and vaginal bleeding. RESULTS: Of the 597 EPLs included, 129 patients (21.6%) had retained products of conception diagnosed at the time of office hysteroscopy. The majority of individuals with EPL were managed surgically (n=427, 71.5%), in lieu of expectant management (n=140, 23.5%) or medical management (n=30, 5.0%). The presence of retained products of conception was significantly associated with vaginal bleeding (relative risk [RR] 1.72, 95% CI 1.34–2.21). Of the 41 patients with normal pelvic ultrasonogram results before office hysteroscopy, 10 (24.4%) had retained products of conception detected at the time of office hysteroscopy. When stratified by EPL management method, retained products of conception were significantly more likely to be present in individuals with EPL who were managed medically (adjusted RR 2.66, 95% CI 1.90–3.73) when compared with those managed surgically. Intrauterine adhesions were significantly less likely to be detected in individuals with EPL who underwent expectant management when compared with those managed surgically (RR 0.14, 95% CI 0.04–0.44). Of the 127 individuals with EPL who were diagnosed with retained products of conception at the time of office hysteroscopy, 30 (23.6%) had retained products of conception dislodged during the office hysteroscopy, 34 (26.8%) chose expectant or medical management, and 63 (49.6%) chose surgical management. The mean number of days from EPL diagnosis to resolution of pregnancy was significantly higher in patients who elected for expectant management (31 days; RR 1.18, 95% CI 1.02–1.37) or medical management (41 days; RR 1.54, 95% CI 1.25–1.90) when compared with surgical management (27 days). CONCLUSION: In patients with EPL after IVF, office hysteroscopy detected retained products of conception in 24.4% of those with normal pelvic ultrasonogram results. Due to the efficacy of office hysteroscopy in diagnosing and treating retained products of conception, these data support considering office hysteroscopy as an adjunct to ultrasonography in patients with infertility who experience EPL after IVF.

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Section: Discussionmentioning

confidence: 99%

Utility of Office Hysteroscopy in Diagnosing Retained Products of Conception Following Early Pregnancy Loss After In Vitro Fertilization

George,

Naert,

Lanes

et al. 2023

Obstetrics &Amp; Gynecology

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“…In 1997, Goldenberg and colleagues reported on the use of hysteroscopy for the management of retained products of conception as a strategy to minimize trauma to the uterus and maximize excision of retained tissue, both of which reduce potential for adhesion formation. 7 Based on these data, several groups have extended the use of hysteroscopic resection for retained tissue to upfront evacuation following pregnancy loss, in lieu of D&C. 8,9 This approach allows for the direct visualization of the focal removal of the implanted pregnancy tissue, which can: • decrease the risk of intrauterine adhesion formation • decrease the risk of retained products of conception • allow for directed tissue sampling to improve the accuracy of cytogenetic testing • allow for detection of embryo anatomic anomalies that often go undetected on traditional cytogenetic analysis.…”

Section: Management Strategiesmentioning

confidence: 99%

Surgical management of early pregnancy loss

Bortoletto¹

2022

OBGM

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Hysteroscopic resection for management of early pregnancy loss: a case report and literature review

Cited by 2 publications

References 30 publications

Utility of Office Hysteroscopy in Diagnosing Retained Products of Conception Following Early Pregnancy Loss After In Vitro Fertilization

Utility of Office Hysteroscopy in Diagnosing Retained Products of Conception Following Early Pregnancy Loss After In Vitro Fertilization

Surgical management of early pregnancy loss

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