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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