European journal of obstetrics, gynecology, and reproductive biology · 2026
Comparison of clinical outcomes for different management strategies of missed miscarriage following in-vitro fertilization/intracytoplasmic sperm injection: a retrospective cohort study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Qin Weiling, Huang Limian, Ou Shanshan, Qin Xiao, Han Jujun, Deng Xiaoxue, Wei Zhaolian
Аннотация
OBJECTIVE: To compare clinical outcomes of expectant, medical and surgical management for early missed abortion (MA) following in-vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET).
METHODS: A retrospective cohort study of 1513 women diagnosed with MA (<13 weeks) after IVF/ICSI-ET between 2011 and 2023 was conducted. Retained products of conception (RPOC) were defined as persistent intrauterine tissue detected on follow-up ultrasound, and intrauterine adhesions (IUA) were diagnosed through hysteroscopic visualization. Crossover cases (i.e. patients initially managed expectantly or medically who subsequently required surgical evacuation) were documented to clarify treatment pathways. Outcomes included procedural complications, IUA formation, endometrial recovery, and reproductive outcomes following the next ET.
RESULTS: Surgical evacuation achieved the highest immediate completion rate, but was associated with a significantly higher risk of IUA. Medical management resulted in a lower IUA rate and better preservation of endometrial thickness, although a modestly higher RPOC rate was observed. Some patients in the expectant and medical management groups required surgical intervention. Subsequent pregnancy and live birth rates did not differ significantly between the three groups.
CONCLUSION: While surgical evacuation provides reliable uterine clearance, medical management may represent an effective initial option in clinically stable patients, preserving endometrial integrity and supporting future reproductive outcomes.
METHODS: A retrospective cohort study of 1513 women diagnosed with MA (<13 weeks) after IVF/ICSI-ET between 2011 and 2023 was conducted. Retained products of conception (RPOC) were defined as persistent intrauterine tissue detected on follow-up ultrasound, and intrauterine adhesions (IUA) were diagnosed through hysteroscopic visualization. Crossover cases (i.e. patients initially managed expectantly or medically who subsequently required surgical evacuation) were documented to clarify treatment pathways. Outcomes included procedural complications, IUA formation, endometrial recovery, and reproductive outcomes following the next ET.
RESULTS: Surgical evacuation achieved the highest immediate completion rate, but was associated with a significantly higher risk of IUA. Medical management resulted in a lower IUA rate and better preservation of endometrial thickness, although a modestly higher RPOC rate was observed. Some patients in the expectant and medical management groups required surgical intervention. Subsequent pregnancy and live birth rates did not differ significantly between the three groups.
CONCLUSION: While surgical evacuation provides reliable uterine clearance, medical management may represent an effective initial option in clinically stable patients, preserving endometrial integrity and supporting future reproductive outcomes.