Hystero-embryoscopy: evaluation and evacuation of spontaneous missed abortions

Objective: To demonstrate the steps for hystero-embryoscopic evaluation of a 7-week spontaneous missed abortion and evacuation of the products of conception. Illustrate the surgical technique and highlight its advantages in improving the evaluation of spontaneous missed abortions. Design: Video case presentation and demonstration of surgical technique. Setting: Tertiary referral center. Patient(s): The patient provided consent for the video and its publication. Intervention(s): Following vaginoscopy, the cervix was approached without prior blind cervical dilation. Navigation from the endo-cervix to the endometrial cavity was performed using a 2.9-mm diameter hysteroscope. The endometrial cavity was thoroughly inspected revealing an intact gestational sac and submucosal fibroids. An operative grasper was introduced, the chorion and amnion were penetrated, and embryoscopy was performed. In -flow was reduced for external morphological inspection of the embryo, which was then grasped and retrieved. The procedure was continued by introducing of a 26-french bipolar resectoscope, after which the products of conception were excised without electricity and sent for histologic and genetic analyses. Main Outcome Measure(s): This procedure allowed for proper embryonic evaluation and hysteroscopic evacuation of products of conception was successfully performed. Result(s): Cytogenic analysis of this case revealed a female embryo with trisomy 15. No maternal and fetal cell admixture was noted in the analysis, allowing a precise diagnosis. Conclusion(s): Hystero-embryoscopy is a valuable diagnostic and therapeutic procedure for cases of missed abortion. It may reveal embryonic morphological abnormalities, expand the diagnostic spectrum in the evaluation of pregnancy loss, and avoid potential complications from blind curettage. ((c) 2022 by American Society for Reproductive Medicine.)