Study Questions Necessity of Early Hysteroscopy After Suction D&C Despite Early Detection of Intrauterine Lesions

The study, published in BMC Women's Health, suggests that early office hysteroscopy following well-monitored suction dilatation and curettage (D&C) with intraoperative sonography may not be necessary. Furthermore, early hysteroscopy allowed early detection of intrauterine lesions (IUA).

"It's important to highlight that while the pregnancy outcomes showed a positive trend in the early hysteroscopy group, there were no statistically significant differences observed," the researchers wrote.

Intrauterine adhesions, commonly known as Asherman's syndrome, are a challenging clinical problem in reproductive infertility. The most common causes are abortions and intrauterine surgery. Kuo-Chung Lan, Kaohsiung Medical University, Kaohsiung, Taiwan, and colleagues aimed to investigate whether early second-look office hysteroscopy can prevent IUA.

To explore the efficacy of early office hysteroscopy after first-trimester induced abortion suction D&C and to further analyze fertility outcomes, the researchers designed a single-center, prospective, two-armed, randomized controlled trial. It recruited women aged 20–45 years undergoing suction D&C and desiring to conceive.

Sixty-six women were enrolled between 2019 and 2022, of whom 33 were allocated to group A (early hysteroscopy intervention). Women in intervention group A were scheduled for two hysteroscopies (early and late), while women in group B underwent only one late hysteroscopy, six months after the suction D&C.

The primary outcome was the rate of intrauterine adhesions, evaluated through office hysteroscopy six months after the artificial abortion. Secondary outcomes included menstrual volume and duration, as well as fertility outcomes.

The study led to the following findings:

· In intervention group A, 31 women underwent the first hysteroscopy examination, and 15 completed the second.

· In group B (late hysteroscopy intervention, 33 patients), 16 completed the hysteroscopic exam six months after an artificial abortion.

· Twenty-one women did not receive late hysteroscopy due to pregnancy.

· The IUA rate was 16.1% (5/31) at the first hysteroscopy in group A, and no IUA was detected during late hysteroscopy.

· Neither group showed statistically significant differences in the follow-up pregnancy and live birth rates.

The researchers concluded that early hysteroscopy after suction D&C can identify intrauterine lesions. Intrauterine adhesions detected early through hysteroscopy may resolve by the time of later examinations, becoming insignificant for future pregnancies. While pregnancy outcomes showed a positive trend in the early hysteroscopy group, we found no statistically significant differences.

"Further studies could investigate the role of hysteroscopy and hyaluronic gel following multiple suction D&Cs and/or medical abortions. This preliminary report may catalyze others to explore and validate these findings," they wrote.

Reference:

Tsai, NC., Hsiao, YY., Su, YT. et al. The efficacy of early office hysteroscopy in preventing intrauterine adhesions after abortion: a randomized controlled trial. BMC Women's Health 24, 400 (2024). https://doi.org/10.1186/s12905-024-03247-0