De Angelis Maria Chiara, Borrelli Danilo, Zizolfi Brunella, Gallo Alessandra, Di Spiezio Sardo Attilio, Carugno Jose
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
Department of Public Health, University of Naples Federico II, Naples, Italy.
Fertil Steril. 2025 Feb;123(2):367-369. doi: 10.1016/j.fertnstert.2024.10.050. Epub 2024 Nov 8.
To describe the technique of embryofetoscopy performed with 5Fr instruments with targeted evacuation of the gestational sac followed by a visual dilatation and curettage (D&C) using the hysteroscopic tissue removal system for the management of first trimester missed abortion in a patient with uterine septum.
Video case-report.
A 32-year-old nulliparous (G3P0020) woman with septate uterus and a 7-week missed abortion. Written informed consent was obtained from the patient.
Transvaginal pelvic ultrasound revealed a 7-week missed abortion. A 3D-ultrasound confirmed the presence of a partial uterine septum. Operative hysteroscopy under spinal anesthesia was performed using a vaginoscopic approach. A partial septum was observed, and a dysmorphic gestational sac was visualized in the left hemicavity.A small incision was made in the amniotic sac using a 5Fr-bipolar electrode allowing direct visualization of the embryo. The entire embryo was removed, and selective biopsies of the chorionic villi using the hysteroscopic "grasp biopsy" technique were obtained. The residual gestational sac was removed using a 6.25 mm tissue retrieval system. No cervical dilation was required.The patient was discharged on the same day of the procedure. No intraoperative bleeding was encountered. The overall operation time was 21 minutes. A postprocedure ultrasound confirmed the presence of an empty cavity. It was determined that further evaluation of the septum was needed before proceeding with hysteroscopic metroplasty.
MAIN OUTCOME MEASURE(S): Step-by-step demonstration of the technique and some tips and tricks for bleeding management.
RESULT(S): Complete evacuation of the uterine cavity under direct visualization.
CONCLUSION(S): Embryofetoscopy with miniaturized instruments allows selective targeting of trophoblastic and fetal tissues, avoiding the risk of maternal tissue contamination of the specimen. As reported in the literature, the visual D&C using tissue retrieval system could be a safe and innovative alternative for the treatment of early pregnancy loss. Compared with the use of hysteroscopic resection, tissue removal devices offer the advantage of not requiring cervical dilation and do not involve the use of electrosurgery, thus reducing damage to the uterine cavity. The combination of embryofetoscopy with visual D&C offers several advantages, especially in patients with congenital uterine anomalies, in which performing a blind D&C has a higher risk of complications.
描述使用5Fr器械进行胚胎镜检查的技术，在子宫纵隔患者中，先有针对性地排空妊娠囊，然后使用宫腔镜组织切除系统进行可视性扩张刮宫术（D&C），以处理孕早期稽留流产。
视频病例报告。
一名32岁未生育（G3P0020）的子宫纵隔女性，发生7周稽留流产。患者签署了书面知情同意书。
经阴道盆腔超声显示7周稽留流产。三维超声证实存在部分子宫纵隔。在脊髓麻醉下采用阴道镜入路进行手术宫腔镜检查。观察到部分纵隔，在左半宫腔可见形态异常的妊娠囊。使用5Fr双极电极在羊膜囊上做一个小切口，以便直接观察胚胎。取出整个胚胎，并使用宫腔镜“抓取活检”技术对绒毛膜绒毛进行选择性活检。使用6.25mm组织取出系统取出残留的妊娠囊。无需宫颈扩张。患者在手术当天出院。术中未发生出血。总手术时间为21分钟。术后超声证实宫腔为空。确定在进行宫腔镜子宫成形术之前需要对纵隔进行进一步评估。
该技术的逐步演示以及出血管理的一些技巧。
在直视下完全排空子宫腔。
使用小型器械进行胚胎镜检查可选择性地针对滋养层和胎儿组织，避免标本受到母体组织污染的风险。如文献报道，使用组织取出系统进行可视性扩张刮宫术可能是治疗早期妊娠丢失的一种安全且创新的替代方法。与使用宫腔镜切除术相比，组织取出装置的优点是无需宫颈扩张，且不涉及使用电外科手术，从而减少对子宫腔的损伤。胚胎镜检查与可视性扩张刮宫术相结合具有多种优势，特别是在先天性子宫异常患者中，进行盲目扩张刮宫术并发症风险更高。
