Hysteroscopy in Libyan women with Recurrent Pregnancy Loss

Abstract

Background: Hysteroscopy is an efficient procedure of management in many gynecologic conditions. There are few published data on hysteroscopy and recurrent pregnancy loss especially in developing countries.
Objectives: To assess hysteroscopic findings in patients with consecutive miscarriages, and to compare the prevalence of uterine abnormalities between women with two and three or more miscarriages.
Methods: Three hundred and twenty four women with two or more consecutive miscarriages were enrolled in the study. All participants underwent a diagnostic hysteroscopy. Congenital (arcuate uterus, septate uterus, unicornuate uterus) and acquired uterine abnormalities (intrauterine adhesions, polyp and submucous myoma) were documented. The findings were compared between the groups of women with two miscarriages and women who had three or more miscarriages.
Results: Out of a total of 324 women [their mean (SD) of the age and gravidity was 28.3 (6.5) years and 5.1(1.5), respectively] 135 (41.7%) and 189 (58.3%) had two consecutive miscarriages and three or more consecutive miscarriages, respectively. While 194 (59.9%) women had no pathological findings on hysteroscopy, 130 (40.1%) women were found to have uterine anomalies. The congenital anomalies were found in 79 (24.4%) and the acquired were in 51 (15.7%) women. In comparison with women who had three or more miscarriages, women who had two miscarriages had significantly higher number of congenital anomalies, 53/135 (39.2%) vs. 26/189 (13.8%), P < 0.001. However there was no significant difference in the acquired anomalies between women who had two miscarriages and women who had three or more miscarriages.
Conclusions: Patients who had two consecutive miscarriages were found to have a higher prevalence of congenital anatomical abnormalities. Diagnostic hysteroscopy should be carried out after two such miscarriages.

Keywords: Hysteroscope, Recurrent Pregnancy Loss, miscarriage, Libya.