Uterine and fetal findings at hysteroscopic evaluation of spontaneous abortions before D&C.

STUDY

OBJECTIVE

To evaluate the diagnostic benefit of fluid hysteroscopy before dilatation and curettage (D&C) in women with missed abortion, with respect to frequency of congenital and acquired uterine anomalies and geographic relationship of uterine anomalies to nidation site.

DESIGN

Prospective case study (Canadian Task Force classification II-2).

SETTING

Obstetric-gynecologic clinic of an academic teaching hospital.

PATIENTS: One hundred five women with one or more recurrent missed abortions.

INTERVENTION: Hysteroscopy before D&C. Inspection of the fetus was attempted in 62 patients. Control hysteroscopy of the nonpregnant uterus was performed in 20 patients.

MEASUREMENTS AND MAIN

RESULTS

The uterine cavity was visualized in 87 patients (83%). These women had an obstetric history significant for 143 spontaneous abortions in 208 pregnancies. Except for three small, finger-shaped polyps in the tubal ostia, no uterine anomalies were detected. In 20 women control hysteroscopy of the nonpregnant uterus confirmed initial findings. The fetus was successfully visualized in 30 cases (48%). We observed one case of umbilical cord torsion at 12 weeks' gestation.

CONCLUSION

Absence of uterine anomalies in patients with single as well as recurrent spontaneous abortions was unexpected since it contradicts the existing literature. However, all previous data were gathered from hysteroscopies of nonpregnant uteri. Larger comparative studies are required.