Ultrasound Guidance to Reduce Complications During Uterine Curettage: A Systematic Review and Meta-Analysis

Surgical management of pregnancy loss with retained products of conception (RPOC), may result in uterine perforation, incomplete evacuation, heavy blood loss, infection or cervical trauma. Ultrasound guidance could reduce complications.

To review studies on uterine curettage for RPOC comparing real-time ultrasound and blinded guidance and perform a meta-analysis to determine whether ultrasound reduces complications.

A systematic literature review was performed to identify studies on 24 August 2023 with further reference mining occurring up until 29 February 2024. Six studies with 1491 participants provided data on 585 participants assigned to ultrasound guidance and 906 assigned to blinded guidance. The measures of treatment effect for dichotomous outcomes-uterine perforation, RPOC, blood loss, infection and cervical trauma-were analysed and compared between the ultrasound and blinded group. A meta-analysis was performed for each outcome using inverse-variance and calculated I² to test heterogeneity. Estimated relative risk (95% CIs), odds ratio (OR, 95% CIs), absolute risk reduction and number needed to treat were calculated. Risk of bias was assessed using the Downs and Black tool and GRADE for certainty.

Five studies including 1218 women provided data for persistent RPOC. Compared to blinded guidance, ultrasound-guided women had a decreased chance of persistent RPOC (OR, 0.19, 95% CI 0.08-0.43, I² 0%, high-certainty evidence). The association between ultrasound guidance and uterine perforation, blood loss, infection and cervical trauma was not significant, with serious concern for imprecision or inconsistency.

Ultrasound reduces the risk of persistent RPOC with a high certainty of evidence.

Prospective register of systematic reviews (PROSPERO): CRD42023447614 (1st August 2023).