Hysteroscopy can shed light on miscarriages.(Obstetrics)(Preevacuation hysteroscopy)

CHICAGO -- Preevacuation hysteroscopy is useful for identifying localized and systemic defects during morphogenesis in patients with unexplained recurring pregnancy loss, said Dr. Artin Ternamian.

"We're convinced that preevacuation hysteroscopy can help us understand and maybe explain a lot of the miscarriages that we take for granted," he said at the annual meeting of the AAGL (formerly the American Association of Gynecologic Laparoscopists).

Sonography, tissue analysis, and biochemical studies are generally used to evaluate recurrent pregnancy loss, which occurs in 1% of reproductive-age women. But once the evacuation or D & C has been performed, couple counseling becomes more difficult, if not impossible, and the willingness to investigate further wanes, he said.

Preevacuation hysteroscopy allows physicians to examine the fetoplacental environment and provides excellent visualization of the surface anatomy before the tissue is eviscerated or contaminated, said Dr. Ternamian, director of gynecologic endoscopy, St. Joseph's Health Centre, University of Toronto.

In particular, one can examine the ventral bony clefts, which can be difficult to do with ultrasound and which reveals subtle skin surface changes, such as human papillomavirus skin lesions or raised corneal lesions that can be targeted for biopsy. The procedure can demonstrate most fetal extremity deformities and the exact topography of the limbs, identifying cystic hydromas and sacral coccygeal keratomas.

The accurate surface observation of hysteroscopy can identify congenital ear abnormalities such as clefts and congenital hairy nevi that are notoriously missed on ultrasound, he said. Preevacuation hysteroscopy can also confirm or rule out amniotic bands, Meckel-Gruber syndrome, Klippel-Trenaunay-Weber syndrome, and first-trimester varicella.

In a prospective, ...