The HYsteroscopic Miscarriage MaNagement (HYMMN) pilot randomized-controlled trial

Area of Science:

• Reproductive Medicine
• Gynecological Surgery
• Clinical Trial Feasibility

Background:

• Retained pregnancy tissue (RPT) after miscarriage can impact future fertility.
• Current standard treatments (ST) for RPT include expectant management, medical treatment, or surgical procedures.
• There is a need to evaluate minimally invasive options like office hysteroscopy (OH) for RPT management.

Purpose of the Study:

• To assess the feasibility of a large-scale randomized controlled trial (RCT) comparing office hysteroscopy (OH) with standard treatment (ST) for retained pregnancy tissue (RPT) after miscarriage.
• To evaluate the impact of OH versus ST on future pregnancy outcomes.

Main Methods:

• A single-center pilot randomized controlled trial (RCT) was conducted.
• Patients with RPT after miscarriage were randomized to either OH or ST.
• Office hysteroscopy utilized the TruClear 5.0 system for tissue retrieval.

Main Results:

• High participant agreement (94.3%) and low attrition rates were observed.
• Office hysteroscopy was well-accepted by all patients with no serious complications.
• The study was not powered to demonstrate statistical significance in pregnancy outcomes but indicated feasibility.

Conclusions:

• A full-scale RCT investigating office hysteroscopy for retained pregnancy tissue is clinically relevant and feasible.
• High participation, acceptability, and satisfaction rates support the potential for a larger trial.
• Office hysteroscopy presents a viable alternative for managing retained pregnancy tissue.