Assessment of 5 miscarriages with transcervical embryoscopy

To report 5 cases of early pregnancy loss in which no morphological abnormalities were detected via transvaginal ultrasound; however, transcervical embryoscopy facilitated the identification of structural anomalies and the collection of uncontaminated fetal material for karyotype analysis.

Video case report.

This study included 5 patients with confirmed miscarriage, ranging in age from 30 to 41 years. The first case involved a 30-year-old, G4P1A2 patient at 8 + 1 weeks of gestation. The second case was a 35-year-old, G1P0 patient at 9 + 2 weeks of gestation. The third case included a 37-year-old, G3A2P0 patient at 6 weeks of gestation, and the fourth case was a 39-year-old, G3A2P0 patient at 9 weeks of gestation. The final case involved a 41-year-old, G3P2 patient at 9 weeks of gestation. Written informed consent was obtained from all participants before the procedure. The respective findings with transcervical embryoscopy were as follows: Cantrell pentalogy; hydrops fetalis; neural cord defect; trisomy 13; and blighted ovum. The patients included in video gave consent for publication and posting of the video online including social media, the journal website, and scientific literature websites.

All cases were confirmed as missed abortions through transvaginal ultrasound. Subsequently, transcervical embryoscopy was performed to evaluate embryonic morphology. In the final case, although transvaginal ultrasound diagnosed a blighted ovum, embryoscopic evaluation revealed the presence of an embryo. No cervical dilation was required for the procedure. All patients were discharged on the same day. The embryo was directly retrieved using a grasper and sent for karyotype analysis.

Step-by-step demonstration of the transcervical embryoscopy technique and visualization of fetal abnormalities.

Successful visualization of fetal morphology and retrieval of embryonic tissue from the uterine cavity.

Transcervical embryoscopy is a valuable diagnostic tool for identifying morphological abnormalities in cases of embryonic demise, thereby potentially elucidating the underlying etiology of missed miscarriage. Furthermore, it allows for the collection of uncontaminated fetal material for karyotype analysis. A key advantage of this technique is that it does not require specialized equipment beyond an office hysteroscope. However, its efficacy is subject to a learning curve, and procedural success may be influenced by factors such as active vaginal bleeding and the duration of embryonic demise.