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Published on: September 12, 2025
Outcomes from blind versus ultrasound-guided uterine evacuation: A retrospective cohort analysis
Sarah Dowthwaite1,2, Ann Quinton3,4, Samantha Thomas2,5
1Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Introduction:
Women may need a surgical uterine evacuation for miscarriage, surgical termination, or retained products of conception. Previous research has indicated possible complications of uterine dilatation and curettage and potential benefits of an ultrasound-guided procedure. This study aimed to compare the rate of complications for uterine evacuation when performed blind or with ultrasound guidance, including whether the presence of patient risk factors determined the use of ultrasound guidance.
Material And Methods:
This retrospective cohort study included 733 cases in an Australian hospital between January 2019 and December 2023. Medical records, imaging, and surgical reports were searched for patient demographics, risk factors, and the presence of surgical complications. Primary outcomes were complications of uterine perforation, false passage, incomplete curettage, heavy blood loss, or laparoscopy. Secondary outcomes were patient demographics and potential presurgical complication factors. The study created two cohorts: patients receiving evacuation performed blind or with ultrasound guidance.
Results:
The uterine evacuation was performed blind for 421/733 (57%) women and ultrasound-guided for 312/733 (43%) women. The ultrasound-guided group included higher gestational ages 8 [7-11] weeks vs blind 8 [7-9] weeks, more patients with risk factors (OR 1.7, CI: 1.3 to 2.3), more patients for surgical termination (OR 15.3, CI: 5.4 to 43.3), or postpartum RPOC removal (OR 2.3, CI: 1.3 to 3.9). The ultrasound group had lower overall blood loss (20 mLs vs 30 mL) and clinically significantly lower volumes of continuing retained products of conception, 0.66 cm3 [0.53-1.23] vs 8.35 cm3 [1.49-18.94]. There was no difference in complications between groups after adjusting for gestational age (OR 1.0, CI: 0.5 to 2.0).
Conclusions:
There were low complication rates for blind and ultrasound-guided uterine evacuations. However, ultrasound guidance was utilized for higher-risk cases and significantly reduced the volume of retained tissue in complicated cases. The use of ultrasound guidance by doctors and sonographers for uterine evacuation is a compelling choice where available.
