The Role of Hysteroscopy in Missed Abortions

Reviewing the possible causes of missed abortions, it becomes obvious that culturing the tissues is the major difficulty and often a setback for the diagnosis. The reason is the difficulty for the geneticist to obtain a representative sample of fetal tissue. In a multicenter trial in Antwerp, Belgium, we designed a technique to use a hysteroscope equipped with a throughflow system and the possibility to pass instruments through a side channel, to view the fetuses from six weeks onwards. First, the sac is opened and inspected for the presence of a yolk sac. In a second step the fetus is visualized and inspected for gross anatomic malformations. If such malformations exist, biopsies are taken to confirm the visual impressions with the genetic results to make a map to diagnose genetic malformations through direct visualization. If no gross malformations are visible, biopsies are taken at specific sites to facilitate the work in the lab. The first results, including the diagnosis of a 45 X aberration, are discussed.