Hysteroscopy Contribution in Unlocated Pregnancy Localization, Diagnosis, and Management

Evaluate diagnostic hysteroscopy (HSC) contribution in early unlocated pregnancy (UP) localization.

A retrospective, observational study.

A single tertiary hospital center.

Patients with early nonviable pregnancies, abnormal plasma beta human chorionic gonadotropin (β-hCG) kinetics (at least three measurements), inconclusive ultrasound concerning pregnancy localization, and hemodynamic stability were included. Between May 2023 and July 2024, a total of 31 consecutive patients were eligible, of whom 27 were included in statistical analysis as they strictly met the inclusion criteria for nonviable pregnancy (β-hCG increase of ≤15% within 48 hours).

Outpatient diagnostic HSC for early nonviable UP. Diagnostic HSC was performed by vaginoscopy using a rigid hysteroscope under physiological saline, in an outpatient visit, without anesthesia.

Diagnostic HSC localized pregnancy in 66.7% of cases (17 intrauterine, 1 cornual) via direct visualization of trophoblastic material. For plasma β-hCG ≥198 international unit/L, HSC detected intrauterine material in 78.3% of cases. Below this threshold, results were inconclusive, either with uterine vacuity or hematometra.

Diagnostic HSC appears to be a useful, feasible tool for UP management, allowing the pregnancy localization in about two-thirds of cases. In our study, a β-hCG threshold of 198 international unit/L was associated with the detection of retained pregnancy tissue. However, further studies are needed to confirm its role, benefits, and the reliable β-hCG threshold for the interpretation of HSC results.