Grossesses arrêtées : aspiration ou hystéroscopie? Les résultats de l’essai randomisé Hy-Per
Seance of wednesday 23 april 2025 (Obstétrique)
DOI number : 10.26299/9ez6-1312/2025.16.01
Abstract
Incomplete Miscarriages: Aspiration or Hysteroscopy? Results of the Hy-Per Randomized Trial
Vacuum aspiration is the standard procedure for removing products of conception after an incomplete spontaneous miscarriage, although it can damage the uterine cavity and potentially impair future fertility. Operative hysteroscopy, which allows for removal under direct visual control, has been proposed as a less invasive alternative, thought to better preserve fertility. The “Hy-Per” clinical trial (Evaluation of the Effectiveness of Hysteroscopy in the Management of Intrauterine Trophoblastic Retention) was conducted to compare both techniques and assess their impact on future fertility.
This multicenter study, funded by the French National Hospital Clinical Research Program (PHRC), was carried out across 15 public hospitals in France. It included 574 women who had experienced an incomplete miscarriage during the first trimester and were hoping to become pregnant in the future. The study compared traditional endometrial aspiration to hysteroscopic removal. The rates of viable pregnancy after two years were similar between the two groups: 67.6% for aspiration and 62.8% for hysteroscopy. Moreover, hysteroscopy was not feasible in all cases.
Published in the JAMA, the study showed no significant benefit of hysteroscopy in terms of improving fertility outcomes or reducing adverse effects. Therefore, it does not support its use as a first-line surgical treatment for incomplete spontaneous miscarriages. These findings support a strong recommendation in favor of the traditional aspiration approach for managing this condition, which affects tens of thousands of women each year in France
Vacuum aspiration is the standard procedure for removing products of conception after an incomplete spontaneous miscarriage, although it can damage the uterine cavity and potentially impair future fertility. Operative hysteroscopy, which allows for removal under direct visual control, has been proposed as a less invasive alternative, thought to better preserve fertility. The “Hy-Per” clinical trial (Evaluation of the Effectiveness of Hysteroscopy in the Management of Intrauterine Trophoblastic Retention) was conducted to compare both techniques and assess their impact on future fertility.
This multicenter study, funded by the French National Hospital Clinical Research Program (PHRC), was carried out across 15 public hospitals in France. It included 574 women who had experienced an incomplete miscarriage during the first trimester and were hoping to become pregnant in the future. The study compared traditional endometrial aspiration to hysteroscopic removal. The rates of viable pregnancy after two years were similar between the two groups: 67.6% for aspiration and 62.8% for hysteroscopy. Moreover, hysteroscopy was not feasible in all cases.
Published in the JAMA, the study showed no significant benefit of hysteroscopy in terms of improving fertility outcomes or reducing adverse effects. Therefore, it does not support its use as a first-line surgical treatment for incomplete spontaneous miscarriages. These findings support a strong recommendation in favor of the traditional aspiration approach for managing this condition, which affects tens of thousands of women each year in France