Current recommendations are for women to be offered an informed choice for expectant, medical or surgical management in pregnancies less than 13 weeks. Many women prefer surgical management because of the speed and predictability of the process, while others opt for medical or expectant management to avoid more invasive procedures or because they feel these options give them a greater sense of control. Therefore, when women make an informed choice surgical management will continue to have an important role. Surgical management is also indicated when medical or expectant management fails or there is heavy bleeding.
During miscarriage as the uterus is enlarged it is more prone to trauma, which can result in bleeding and perforation. Some of tissues of conception maybe retained and infection can be introduced into the uterine cavity. Both trauma and infection are implicated in the formation of intrauterine adhesions (Asherman’s syndrome), which are associated with pain, amenorrhoea, placental implantation problems and decreased fertility.
In an effort to decrease perforation and ensure complete removal of retained products it has been proposed that hysteroscopic techniques can be used. However, hysteroscopic techniques could greatly increase the cost of the procedure and the visual field can be severely compromised when there is heavy bleeding limiting their application to chronically retained products of conception. Another way of visualising the cavity is with ultrasound. With the advent of cheap and portable ultrasound devices, the availability of ultrasound and the skills needed to perform ultrasound are increasingly being disseminated through the field of gynaecology.
Intraoperative ultrasound could reduce the incidence of the perforation during operative procedures in the treatment of first trimester miscarriage. Furthermore, intraoperative ultrasound can ensure complete removal of products while minimising trauma to the cavity that could cause intrauterine adhesions.
The aim of the feasibility study is to find out if an appropriately powered randomised controlled trial (RCT) can be realistically undertaken to answer this research question. The feasibility study will allow the research team to identify any barriers to recruitment and compliance, and fine tune study procedures.
The aim of the definitive study would be to test the premise that intraoperative ultrasound can reduce the incidence of early and late complications following surgical removal of products of conception.