Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?

Omer Moore*, Tamar Tzur, Zvi Vaknin, Moran Landau Rabbi, Noam Smorgick

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: To describe the feasibility of hysteroscopy-assisted suction curettage for early pregnancy loss and to investigate whether it reduces the rates of retained products of conception (RPOC) and intrauterine adhesions (IUA). Design: Prospective single-arm cohort study. Setting: University-affiliated Department of Obstetrics and Gynecology. Patients: Women admitted for surgical evacuation of early pregnancy loss were invited to participate in the study. Intervention: Vaginal misoprostol was administered for cervical ripening preoperatively. Under general anesthesia, a diagnostic hysteroscopy was performed to identify the pregnancy’s implantation wall, followed by ultrasound-guided suction and curettage directed to the implantation wall, and then diagnostic hysteroscopy to verify complete uterine cavity emptying. Postoperative IUA were evaluated by follow-up office hysteroscopy. Main Outcome Measure: Identification of the pregnancy’s implantation wall on hysteroscopy, and intra-, and postoperative complications associated with the procedure. The evaluation of postoperative IUA was limited due to the COVID-19 pandemic-related restrictions on elective procedures. Results: Forty patients were included in the study group. Their mean age was 34.0 ± 6.6 years, and their mean gestational age was 8.9 ± 1.6 weeks. The implantation wall was clearly visualized on hysteroscopy in 33 out of 40 cases (82.5%). The mean operative time was 17.2 ± 8.8 min, and no intraoperative complications occurred. Suspected RPOC were diagnosed intraoperatively by hysteroscopy and removed in 4 cases, and the histologic examination confirmed the presence of RPOC in three of them. Follow-up office hysteroscopy was performed in nine women: mild IUA was diagnosed in one case and a normal cavity was confirmed in eight cases. A new pregnancy was reported at the time of follow-up in 15 cases, while 12 women declined to attend the follow-up hysteroscopy and four were lost to follow-up. Conclusions: Hysteroscopy-assisted suction curettage for early pregnancy loss is a safe, short, and inexpensive procedure, which allows the identification of the pregnancy’s wall in most cases and may reduce the rates of RPOC.

Original languageEnglish
Pages (from-to)205-210
Number of pages6
JournalArchives of Gynecology and Obstetrics
Issue number1
StatePublished - Jan 2024


  • Early pregnancy loss
  • Hysteroscopy
  • Intrauterine adhesions
  • Retained products of conception
  • Suction and curettage


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