Application of Narrow-band Imaging Combined with Hysteroscopic 7Fr Cold Knife in the Treatment of Missed Early Miscarriage

Overview

Journal Arch Gynecol Obstet

Date 2025 Jan 19

PMID 39828775

Authors

Yan Lei

Xin Du

Yu Liu

Yuqin Tang

Affiliations

Soon will be listed here.

Abstract

Purpose: The application of narrow-band imaging for missed early miscarriage treatment remains unclear. This study determined the application advantages of NBI combined with hysteroscopic 7Fr cold knife embryo removal for treating missed early miscarriage.

Methods: A retrospective selection of 208 patients who were hospitalized for missed early miscarriage at Hubei Provincial Maternal and Child Health Hospital from January 2023 to June 2023 were included. The patients were divided into three groups according to the treatment methods: Group A (medical abortion), Group B (NBI combined with hysteroscopic 7Fr cold knife), and Group C (ultrasound-guided vacuum aspiration). The clinical data of the three groups were analyzed, and endometrial recovery after treatment was compared to identify risk factors affecting complications after treatment for missed early miscarriage.

Results: The endometrial thickness was greatest in Group A and thinnest in Group C two weeks post-treatment. Group B had the earliest menstrual recovery and the lowest intrauterine residual and intrauterine adhesion incidences. The pregnancy termination method was the only independent risk factor for intrauterine adhesions after treatment. The time to menstrual recovery after treatment, the serum beta-human chorionic gonadotropin level at 2 weeks post-treatment, and the endometrial thickness had predictive value for intrauterine retention. The combined prediction of the above indicators showed high accuracy.

Conclusion: The use of NBI combined with hysteroscopic 7Fr cold knife embryo removal in patients with missed early miscarriage results in a lower risk of intrauterine residuals and IUA than ultrasound-guided vacuum aspiration and medical abortion. This approach leads to earlier menstrual recovery and protects the endometrium.

References

Harris L, Grossman D . Complications of Unsafe and Self-Managed Abortion. N Engl J Med. 2020; 382(11):1029-1040. DOI: 10.1056/NEJMra1908412. View

Kapp N, Eckersberger E, Lavelanet A, Rodriguez M . Medical abortion in the late first trimester: a systematic review. Contraception. 2018; 99(2):77-86. PMC: 6367561. DOI: 10.1016/j.contraception.2018.11.002. View

de Codt M, Balza C, Jadoul P, Forget P, Squifflet J, Bernard P . Hysteroscopic Resection for Missed Abortion: Feasibility, Operative Technique and Potential Benefit Compared to Curettage. Front Surg. 2020; 7:64. PMC: 7505996. DOI: 10.3389/fsurg.2020.00064. View

Cohen S, Weisz B, Zalel Y, Seidman D, Mashiach S, Lidor A . Hysteroscopy may be the method of choice for management of residual trophoblastic tissue. J Am Assoc Gynecol Laparosc. 2001; 8(2):199-202. DOI: 10.1016/s1074-3804(05)60577-4. View

Ben-Ami I, Melcer Y, Smorgick N, Schneider D, Pansky M, Halperin R . A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception. Int J Gynaecol Obstet. 2014; 127(1):86-9. DOI: 10.1016/j.ijgo.2014.05.003. View

Huchon C, Drioueche H, Koskas M, Agostini A, Bauville E, Bourdel N . Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion: A Randomized Clinical Trial. JAMA. 2023; 329(14):1197-1205. PMC: 10091175. DOI: 10.1001/jama.2023.3415. View

Huchon C, Deffieux X, Beucher G, Capmas P, Carcopino X, Costedoat-Chalumeau N . Pregnancy loss: French clinical practice guidelines. Eur J Obstet Gynecol Reprod Biol. 2016; 201:18-26. DOI: 10.1016/j.ejogrb.2016.02.015. View

Creinin M, Chen M . Medical abortion reporting of efficacy: the MARE guidelines. Contraception. 2016; 94(2):97-103. DOI: 10.1016/j.contraception.2016.04.013. View

10.

Lane B, Wong-You-Cheong J, Javitt M, Glanc P, Brown D, Dubinsky T . ACR appropriateness Criteria® first trimester bleeding. Ultrasound Q. 2013; 29(2):91-6. DOI: 10.1097/RUQ.0b013e31829158c2. View

11.

Knopman J, Copperman A . Value of 3D ultrasound in the management of suspected Asherman's syndrome. J Reprod Med. 2007; 52(11):1016-22. View

12.

Costescu D, Guilbert E . No. 360-Induced Abortion: Surgical Abortion and Second Trimester Medical Methods. J Obstet Gynaecol Can. 2018; 40(6):750-783. DOI: 10.1016/j.jogc.2017.12.010. View

13.

Ehrnsten L, Altman D, Ljungblad A, Kopp Kallner H . Efficacy of mifepristone and misoprostol for medical treatment of missed miscarriage in clinical practice-A cohort study. Acta Obstet Gynecol Scand. 2019; 99(4):488-493. DOI: 10.1111/aogs.13780. View

14.

Rein D, Schmidt T, Hess A, Volkmer A, Schondorf T, Breidenbach M . Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage. J Minim Invasive Gynecol. 2011; 18(6):774-8. DOI: 10.1016/j.jmig.2011.08.003. View

15.

Dreisler E, Kjer J . Asherman's syndrome: current perspectives on diagnosis and management. Int J Womens Health. 2019; 11:191-198. PMC: 6430995. DOI: 10.2147/IJWH.S165474. View

16.

Stevens S, McManus R, Stevens R . The utility of long-term blood pressure variability for cardiovascular risk prediction in primary care. J Hypertens. 2018; 37(3):522-529. DOI: 10.1097/HJH.0000000000001923. View

17.

Zhou Q, Shi X, Saravelos S, Huang X, Zhao Y, Huang R . Auto-Cross-Linked Hyaluronic Acid Gel for Prevention of Intrauterine Adhesions after Hysteroscopic Adhesiolysis: A Randomized Controlled Trial. J Minim Invasive Gynecol. 2020; 28(2):307-313. DOI: 10.1016/j.jmig.2020.06.030. View

18.

Tsapanos V, Stathopoulou L, Papathanassopoulou V, Tzingounis V . The role of Seprafilm bioresorbable membrane in the prevention and therapy of endometrial synechiae. J Biomed Mater Res. 2002; 63(1):10-4. DOI: 10.1002/jbm.10040. View

19.

Capmas P, Mihalache A, Duminil L, Hor L, Pourcelot A, Fernandez H . Intrauterine adhesions: What is the pregnancy rate after hysteroscopic management?. J Gynecol Obstet Hum Reprod. 2020; 49(7):101797. DOI: 10.1016/j.jogoh.2020.101797. View

20.

Sellmyer M, Desser T, Maturen K, Jeffrey Jr R, Kamaya A . Physiologic, histologic, and imaging features of retained products of conception. Radiographics. 2013; 33(3):781-96. DOI: 10.1148/rg.333125177. View

21.

Moore O, Tzur T, Vaknin Z, Rabbi M, Smorgick N . Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?. Arch Gynecol Obstet. 2023; 309(1):205-210. DOI: 10.1007/s00404-023-07238-8. View