Ultrasound-guided surgical suction evacuation (US-SSE) for missed miscarriage

Introduction:Surgical evacuation of the uterine contents in first trimester missed miscarriage is a blind procedure, carrying a risk of complications. This study was designed to evaluate the outcome of the implemented protocol of ultrasound-guided surgical suction evacuation (US-SSE) for first trimester missed miscarriage.

Material and methods:Two hundred and twenty women diagnosed with missed miscarriage in the first trimester of pregnancy were included in this study and classified in two groups: 124 women in the US-SSE group, and 94 women in the blind surgical suction evacuation (B-SSE) group. Outcome measures: operative time, hemoglobin loss, hospital stay, cervical trauma, uterine perforation, retained products of conception (RPOC) requiring repeat evacuation, and post-operative infection.

Results:The hemoglobin loss was significantly lower in the US-SSE group compared to B-SSE (0.9 ±1.1 vs. 1.2 ±0.8 gms% ; respectively, p = 0.0006), and the hospital stay was significantly shorter in the US-SSE group compared to B-SSE (1.1 ±1.3 vs. 1.5 ±0.9 days; respectively, p = 0.0001). Cervical trauma was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 2 (2.08%); respectively, p = 0.05), and uterine perforation was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 2 (2.08%); respectively, p = 0.05). Post-operative endometritis was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 3 (3.13%); respectively, p = 0.02), and RPOC requiring repeat evacuation was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 4 (4.16%); respectively, p = 0.007).

Conclusions:US-SSE for first trimester missed miscarriage is safer than the B-SSE method, and is associated with significant reduction of intra-operative and post-operative complications.