Hysteroscopic Morcellation for Management of Early Pregnancy Loss: Evaluation of Clinical Outcomes.

STUDY

OBJECTIVE

To evaluate clinical outcomes of hysteroscopic morcellation for evacuation of early pregnancy loss, including the rate of postoperative intrauterine adhesions and the ability to obtain genetic testing results, and to 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

Postoperative intrauterine adhesion rate, with secondary measures of complication rate and ability to acquire tissue genetic testing. 177 patients completed their postoperative saline-infused sonohysterogram. There were no postoperative 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 postoperative 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 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 the management of early pregnancy loss with a low rate of complications and intrauterine adhesions postoperatively.