Targeted removal of a small gestational sac in early pregnancy loss via hysteroscopy: distinguishing the true gestational sac from two pseudogestational sacs and a submucosal fibroid
To demonstrate the techniques and advantages of targeted gestational sac removal via hysteroscopy in a case of early miscarriage. Video article. A 41-year-old woman with a missed miscarriage at 7 Non-contact hysteroscopy was conducted without uterine probing or cervical dilation using HEOS-mini hysteroscope (Delmont, France). The true gestational and pseudogestational sacs and submucosal fibroids were identified and removed using a grasper. Intraoperative intravenous oxytocin (10 IU in 500 mL normal saline) was administered to enhance the visualization of fibroids. Surgical skills were discussed in detail. This study was approved by the Ethics Committee of The First Affiliated Hospital, Zhejiang University School of Medicine (IIT2024-0505). Successful targeted removal of the gestational sac and intrauterine lesions. Cytogenetic analysis of the chorionic villi revealed a 45,XO karyotype. Histopathological findings confirmed the hysteroscopic diagnosis. The postoperative recovery was uneventful. Targeted removal of the gestational sac in early pregnancy loss via hysteroscopy is both feasible and effective. It offers valuable diagnostic and therapeutic benefits for patients with recurrent pregnancy loss who require precise sampling or those with concurrent intrauterine abnormalities.