Young Stacy, Miller Charles E
University Medical Partners, Stanford Health Care, Hayward, California.
Department of Obstetrics and Gynecology, University of California, San Francisco, California.
F S Rep. 2022 Mar 10;3(2):163-167. doi: 10.1016/j.xfre.2022.03.002. eCollection 2022 Jun.
To report a case of early pregnancy loss successfully managed by hysteroscopic resection, review the literature comparing hysteroscopic resection to dilation and curettage for retained products of conception, and review potential advantages of hysteroscopic resection over dilation and curettage for management of early pregnancy loss.
Case report.
Private practice.
One woman with early pregnancy loss.
Hysteroscopic resection using a mechanical morcellation device.
Complete uterine evacuation after hysteroscopic resection as demonstrated by a normal transvaginal ultrasound and cessation of bleeding 2 weeks after surgery.
The hysteroscopic fluid deficit was 365 ml, with minimal blood loss. Products of conception were confirmed on pathologic examination. There were no intraoperative or postoperative complications. A saline infusion sonogram obtained 4 months after surgery demonstrated a normal endometrial cavity with no intrauterine adhesions.
Surgical management of early pregnancy loss may be complicated by retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Hysteroscopic resection of RPOC has been associated with fewer cases of intrauterine adhesions, more cases of complete tissue removal, and earlier time to conception compared with dilation and curettage. Early pregnancy loss can also be characterized as RPOC with potentially similar benefits from hysteroscopic resection. Thus, hysteroscopic resection can be considered as an alternative surgical technique for management of early pregnancy loss. This case report demonstrates the successful application of hysteroscopic resection in a case of early pregnancy loss.
报告一例经宫腔镜切除术成功治疗的早期妊娠丢失病例，回顾比较宫腔镜切除术与刮宫术治疗妊娠物残留的文献，并探讨宫腔镜切除术相较于刮宫术治疗早期妊娠丢失的潜在优势。
病例报告。
私人诊所。
一名早期妊娠丢失的女性。
使用机械旋切装置进行宫腔镜切除术。
宫腔镜切除术后经阴道超声显示子宫完全排空，术后2周出血停止。
宫腔镜手术中液体缺失365毫升，失血极少。病理检查证实有妊娠物。无术中或术后并发症。术后4个月的盐水灌注超声检查显示子宫内膜腔正常，无宫腔粘连。
早期妊娠丢失的手术治疗可能因妊娠物残留（RPOC）或宫腔粘连形成而复杂化，这可能导致未来不良的生育结局。与刮宫术相比，宫腔镜切除RPOC导致宫腔粘连的病例较少，完全清除组织的病例较多，受孕时间更早。早期妊娠丢失也可表现为RPOC，宫腔镜切除术可能带来类似的益处。因此，宫腔镜切除术可被视为治疗早期妊娠丢失的一种替代手术技术。本病例报告展示了宫腔镜切除术在早期妊娠丢失病例中的成功应用。
