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Grand Rounds

Can Operative Hysteroscopy Improve Fetal Chromosome Detection Following Miscarriage?

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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

METHODS:

  • Retrospective chart review
  • Participants
    • 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

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%

CONCLUSION:

  • 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

Learn More – Primary Sources:

Increased fetal chromosome detection with the use of operative hysteroscopy during evacuation of products of conception for diagnosed miscarriage

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Related ObG Topics:

Early Pregnancy Loss: How to Make the Ultrasound Diagnosis
Managing Early Pregnancy Loss

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