Operative hysteroscopy-assisted pregnancy termination after failed surgical abortion in missed abortion of woman with complete septate uterus

Abstract

First trimester surgical abortion is an effective and safe procedure. Although its failure is uncommon, congenital uterine anomaly may be considered as one of the etiologic factors in such cases. Here, we report a rare case of surgical abortion failure that was successfully managed by operative hysteroscopy-assisted dilatation and evacuation (D&E) under ultrasound guidance in a woman with complete uterine septum. The patient was referred to Severance Hospital after two consecutive surgical abortion failures even under ultrasound guidance. A missed abortion in a leftsided hemicavity of septate uterus was noted on ultrasonography. Ultrasound-guided D&E was unsuccessful because the curette could not reach the uterine cavity with the gestational sac. Operative hysteroscopy revealed insufficient communication with the left-sided cavity just above the cervical internal os of the uterine septum. After widening the communication, ultrasound-guided D&E was successfully performed.

Retracted: Misoprostol versus expectant management in women with incomplete first‐trimester miscarriage after failed primary misoprostol treatment: A randomized clinical trial

“…2,3 For many years, surgical evacuation of the uterus was considered the reference standard management to remove the retained tissue in an incomplete miscarriage. 4 It is quickly performed and removes almost all the retained products of conception. However, it carries the risk of anesthesia, bleeding, infection, and perforation.…”

Operative hysteroscopy assisted evacuation of a non-viable pregnancy in the setting of a congenital uterine anomaly - bicornuate bicollis

“…A similar case was published by Ryu et al with ultrasonography suggestive of a missed abortion in a leftsided hemicavity of the septate uterus. 6 Ultrasound-guided D&E was attempted but did not work as the gestational sac was blocking the curette's path into the uterus. Insufficient connectivity with the left-sided cavity right above the cervical internal os of the uterine septum was discovered during an operational hysteroscopy.…”

“…Following increased communication, ultrasound-guided D&E was carried out effectively. 6 In another case report published by Setchell et al, flexible hysteroscopy, in combination with transabdominal ultrasound, was used to facilitate the correct passage of the dilators during a successful dilatation and evacuation (D&E) followed by insertion of intra-uterine progestogen-only contraceptive system ('Mirena'). 7…”

Predictor assessment of complete miscarriage after medical treatment for early pregnancy loss in women with previous cesarean section

“…[2][3][4][5][6] For many years, uterine evacuation procedures have been commonly used as the standard management for EPL. [7] However, it carries the risk of anesthesia, bleeding, infection, and perforation, [8,9] especially for women who have had previous cesarean deliveries. Alternatively, medical treatment has emerged and been pursued by both healthcare providers and patients to minimize the complications of surgical interventions.…”