Can Operative Hysteroscopy Improve Fetal Chromosome Detection Following Miscarriage?
BACKGROUND AND PURPOSE:
50% of all miscarriages are associated with chromosomal anomalies
Sampling of products of conception (POC) by suction curettage can result in maternal cell contamination and limited cytogenetic assessment
Cholkeri-Singh et al. (JMIG, 2019) investigated whether the use of operative hysteroscopy with biopsy can result in less maternal cell contamination and consequent increase in detection of fetal chromosomes
Retrospective chart review
Infertility patients undergoing evacuation of POC following first trimester miscarriages
Authors compared the following surgical treatments
Surgical group 1: Suction curettage only or diagnostic hysteroscopy followed by suction curettage
Surgical group 2: Operative hysteroscopy, biopsy of chorionic villi and/or fetus, followed by suction curettage
Primary outcome: Difference in maternal cell contamination
Secondary outcome: Rates of retained products following suction curettage, determined by hysteroscopy
Additional data collected including demographics and ultrasound results
264 charts were analyzed
Group 1: 174 patients
Group 2: 90 patients
Groups were similar for a variety of demographical variables, such as
Age | BMI | Ethnicity | Gravida | Parity | Primary infertility | Secondary infertility | Spontaneous conception | Single or multiple gestation | Surgical complications
Fetal chromosome detection was significantly higher in the group that included hysteroscopy (P<0.001)
Group 1: 64.8% (maternal cell contamination 24.4%)
Group 2: 88.5% (maternal cell contamination 8.2%)
No significant difference in postoperative retained products of conception between both groups (P=0.477)
Group 1: 3.1%
Group 2: 5.0%
Hysteroscopic guided biopsy results in less maternal cell contamination and consequent improvement of fetal chromosome analysis
Hysteroscopy following suction curettage does not reduce postoperative retained products of conception
Authors acknowledge that newer molecular techniques (e.g., microarray) may replace standard karyotyping in some centers
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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