Hysteroscopic Resection for Missed Abortion: Feasibility, Operative Technique and Potential Benefit Compared to Curettage
Objective: To evaluate the feasibility of hysteroscopic resection (HsR) for primary surgical management of missed abortion. Reproductive outcomes and potential benefit of this technique will be compared to traditional dilatation and curettage (D&C).Design: Retrospective cohort study in two D...
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Frontiers Media S.A.
2020-09-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fsurg.2020.00064/full |
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| author | Matthieu de Codt Claire Balza Pascale Jadoul Patrice Forget Jean-Luc Squifflet Pierre Bernard Mathieu Luyckx |
| author_facet | Matthieu de Codt Claire Balza Pascale Jadoul Patrice Forget Jean-Luc Squifflet Pierre Bernard Mathieu Luyckx |
| author_sort | Matthieu de Codt |
| collection | DOAJ |
| description | Objective: To evaluate the feasibility of hysteroscopic resection (HsR) for primary surgical management of missed abortion. Reproductive outcomes and potential benefit of this technique will be compared to traditional dilatation and curettage (D&C).Design: Retrospective cohort study in two Departments (Gynecology and Obstetrics) of a tertiary medical care center (Canadian Task Force classification II-2).Patients: Women with first trimester missed abortion.Intervention: Two techniques were used for the management of missed abortion: ultrasound-guided dilatation and curettage (D&C) and hysteroscopic resection (HsR).Results: We evaluated 358 patients who underwent primary surgical removal of missed abortion. Hundred seventy three patients have been treated by D&C and 185 underwent HsR. In the HsR group, 110 patients (59.5%) have obtained their pregnancy with in vitro fertilization (IVF) vs. 7 patients (4.0%) in the D&C group which make the HsR population hypofertile in comparison to the D&C population. The intra- and post-operative complication rates are low and comparable. Intrauterine anomalies were diagnosed during the HsR in 10 patients (5.4%) and could be investigated after the intervention as a possible cause of miscarriage. Because of the difference in term of fertility, the reproductive outcomes have been analyzed by multivariate analysis. The hazard ratio of pregnancy at 6 months, adjusted to the factor IVF for D&C compared to HsR is 0.69 [0.49–0.96] (p = 0.026). That could represent a significant benefit in the particular population followed in IVF, but regarding the retrospective analysis, and the very different population in the two groups, it doesn't allow us to draw any evidence based conclusion.Conclusion: Hysteroscopic resection is a feasible and safe procedure for the management of missed abortion that could increase the diagnosis of uterine abnormalities. With all the limitation of the design of our study, our data seems to show a trend to a potential benefit in term of reproductive outcomes for hypofertile patient undergoing IVF treatment. |
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| id | doaj.art-eec3f49530884bc78178f4f3c8024d1e |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-13T11:31:03Z |
| publishDate | 2020-09-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Surgery |
| spelling | doaj.art-eec3f49530884bc78178f4f3c8024d1e2022-12-21T23:47:55ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2020-09-01710.3389/fsurg.2020.00064562412Hysteroscopic Resection for Missed Abortion: Feasibility, Operative Technique and Potential Benefit Compared to CurettageMatthieu de Codt0Claire Balza1Pascale Jadoul2Patrice Forget3Jean-Luc Squifflet4Pierre Bernard5Mathieu Luyckx6Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumClinical Chair in Anaesthesia, University of Aberdeen, Honorary Consultant, NHS Grampian, Aberdeen, United KingdomDepartment of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Obstetrics, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumObjective: To evaluate the feasibility of hysteroscopic resection (HsR) for primary surgical management of missed abortion. Reproductive outcomes and potential benefit of this technique will be compared to traditional dilatation and curettage (D&C).Design: Retrospective cohort study in two Departments (Gynecology and Obstetrics) of a tertiary medical care center (Canadian Task Force classification II-2).Patients: Women with first trimester missed abortion.Intervention: Two techniques were used for the management of missed abortion: ultrasound-guided dilatation and curettage (D&C) and hysteroscopic resection (HsR).Results: We evaluated 358 patients who underwent primary surgical removal of missed abortion. Hundred seventy three patients have been treated by D&C and 185 underwent HsR. In the HsR group, 110 patients (59.5%) have obtained their pregnancy with in vitro fertilization (IVF) vs. 7 patients (4.0%) in the D&C group which make the HsR population hypofertile in comparison to the D&C population. The intra- and post-operative complication rates are low and comparable. Intrauterine anomalies were diagnosed during the HsR in 10 patients (5.4%) and could be investigated after the intervention as a possible cause of miscarriage. Because of the difference in term of fertility, the reproductive outcomes have been analyzed by multivariate analysis. The hazard ratio of pregnancy at 6 months, adjusted to the factor IVF for D&C compared to HsR is 0.69 [0.49–0.96] (p = 0.026). That could represent a significant benefit in the particular population followed in IVF, but regarding the retrospective analysis, and the very different population in the two groups, it doesn't allow us to draw any evidence based conclusion.Conclusion: Hysteroscopic resection is a feasible and safe procedure for the management of missed abortion that could increase the diagnosis of uterine abnormalities. With all the limitation of the design of our study, our data seems to show a trend to a potential benefit in term of reproductive outcomes for hypofertile patient undergoing IVF treatment.https://www.frontiersin.org/article/10.3389/fsurg.2020.00064/fullmissed abortionmanagementcurettagehysteroscopic resectionreproductive outcomes |
| spellingShingle | Matthieu de Codt Claire Balza Pascale Jadoul Patrice Forget Jean-Luc Squifflet Pierre Bernard Mathieu Luyckx Hysteroscopic Resection for Missed Abortion: Feasibility, Operative Technique and Potential Benefit Compared to Curettage Frontiers in Surgery missed abortion management curettage hysteroscopic resection reproductive outcomes |
| title | Hysteroscopic Resection for Missed Abortion: Feasibility, Operative Technique and Potential Benefit Compared to Curettage |
| title_full | Hysteroscopic Resection for Missed Abortion: Feasibility, Operative Technique and Potential Benefit Compared to Curettage |
| title_fullStr | Hysteroscopic Resection for Missed Abortion: Feasibility, Operative Technique and Potential Benefit Compared to Curettage |
| title_full_unstemmed | Hysteroscopic Resection for Missed Abortion: Feasibility, Operative Technique and Potential Benefit Compared to Curettage |
| title_short | Hysteroscopic Resection for Missed Abortion: Feasibility, Operative Technique and Potential Benefit Compared to Curettage |
| title_sort | hysteroscopic resection for missed abortion feasibility operative technique and potential benefit compared to curettage |
| topic | missed abortion management curettage hysteroscopic resection reproductive outcomes |
| url | https://www.frontiersin.org/article/10.3389/fsurg.2020.00064/full |
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