Hysteroscopy in pregnancy-related conditions: descriptive analysis in 273 patients

Abstract

Study objective: To describe the feasibility of office hysteroscopy in patients with pregnancy-related problems such as retained trophoblastic tissue, persistent molar tissue, pregnancy with in situ intrauterine device (IUD), isthmocele, embryoscopy, and osseous metaplasia.

Design: Retrospective cohort chart review of use of hysteroscopy in 273 patients with pregnancy-related conditions (Canadian Task Force classification II-2).

Setting: University tertiary-care hospital.

Patients: Office hysteroscopy with the indication of pregnancy-related conditions such as retained trophoblastic tissue, pregnancy with IUD, molar pregnancy, cesarean scar defects, and fetal death were studied. The study included 273 patients: 185 with retained trophoblastic tissue, 14 with persistent molar tissue, 7 with an in situ IUD, 22 with symptomatic isthmocele, 41 with embryoscopy, and 4 with osseous metaplasia.

Intervention: Diagnostic and operative office hysteroscopy.

Measurements and main results: Variables studied included resolution of abnormal uterine bleeding in patients with persistent trophoblastic tissue, normalization of β-human chorionic gonadotropin levels in patients with persistent molar tissue, continuation of pregnancy after retrieval of lost IUDs, resolution of postmenstrual bleeding in patients with symptomatic isthmocele, rate of uncontaminated embryonic tissue after embryoscopic biopsy, and successful extraction of bony tissue in patients with osseous metaplasia. Office hysteroscopy enabled resolution of most cases of retained trophoblastic tissue (91.8%) and all 14 cases of persistent molar tissue. 7 IUDs were extracted from pregnant patients. Fifteen isthmoceles resolved with office hysteroscopy, and 7 were resected in the operating room. A normal karyotype was obtained in 37 embryoscopies (90.2%). Four osseous metaplasia cases resolved with either office hysteroscopy (75%) or resectoscopy in the operating room (25%).

Conclusion: Office hysteroscopy is a safe and minimally invasive treatment for pregnancy-related conditions, with good clinical and functional results.

Keywords: Embryoscopy; Intrauterine device; Isthmocele; Office hysteroscopy; Osseous metaplasia; Persistent molar tissue; Persistent trophoblastic tissue.