Korean J Obstet Gynecol.  2005 Feb;48(2):363-369.

Transcervical embryoscopy in missed abortion

Affiliations
  • 1Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, SungKyunKwan University, School of Medicine, Seoul, Korea. mkkoong2004@yahoo.co.kr

Abstract


OBJECTIVE
Approximately 15-20% of all clinically recognized pregnancies result in spontaneous abortion and 60-70% of these are attributable to detectable chromosome abnormalities. Although the incidence of first trimester losses is high, spontaneous abortion material is often poorly described from a development perspective. The purpose of this study was to determine the usefulness of transcervical embryoscopy in diagnosing localized and generalized defects in the embryonic morphogenesis of missed abortions. The embryoscopic findings are supplemented by the results of cytogenetic analysis in all cases.
METHODS
In this study, consisted of 26 women with the final diagnosis of missed abortion between August 1, 2003 and October 31, 2003 in Samsung Cheil Hospital. Prior to the instrumental evacuation of the uterus a rigid hysteroscope was passed transcervically into the amniotic cavity to obtain a detail view of the embryo. Karyotyping was done in all cases included in this study.
RESULTS
Visualization of embryo or early fetus was successful in 24 cases. Among 24 examined cases, 21 cases had successful karyotype and as a result 11 (11/21, 52.4%) had abnormal karyotype. Among 21 cases which had successful karyope, 4 (4/21, 19.0%) had normal external features, 10 (10/21, 47.6%) had classified as growth-disorganized and 7 (7/21, 33.3%) had either isolated or multiple defects, including facial dysplasia, delayed limb development, facial fusion to chest, umbilical cyst, brownish discoloration of ventral part and increased nuchal thickness. Of the morphologically normal and growth-disorganized embryo in embryoscopic examination, only 1 and 4 (1/4, 25.0% and 4/10, 40.0%) had a abnormal karyotype. In contrast, of the morphologically abnormal embryo in embryoscopic examination, 5 (5/7, 71.4%) had a abnormal karyotype.
CONCLUSION
Transcervical embryoscopy permits visualization of the embryo in utero, unaffected by the damage usually caused by its instrumental evacuation or spontaneous passage. This technique can be a helpful tool for understanding human embryonic malformations and genetic counseling for parents. Futhermore, correlation of morphological and cytogenetic findings in spontaneous abortion specimens could provide the need of further evaluation for future pregnancies in couples which had fear of repeated abortions. But, more larger scaled controlled study is needed for widely use of transcervical embryoscopy in missed abortion.

Keyword

Missed abortion; Embryoscopy; Anomaly; Chromosome analysis

MeSH Terms

Abnormal Karyotype
Abortion, Missed*
Abortion, Spontaneous
Chromosome Aberrations
Cytogenetic Analysis
Cytogenetics
Diagnosis
Embryonic Structures
Extremities
Family Characteristics
Female
Fetoscopy*
Fetus
Genetic Counseling
Humans
Hysteroscopes
Incidence
Karyotype
Karyotyping
Morphogenesis
Parents
Pregnancy
Pregnancy Trimester, First
Thorax
Urachal Cyst
Uterus
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