Diagnosis of umbilical cord torsion as the probable cause of miscarriage at 12 weeks' gestation using "abortion hysteroscopy"

A 21-year old 2(nd)-gravida, nulliparous woman, status post miscarriage two years earlier, was admitted for curettage at 12 weeks' gestation with a sonographically appropriate yet non-vital pregnancy. Before the curettage, fluid hysteroscopy was performed in the same sitting. An uterine anomaly as a possible cause of the miscarriage could be ruled out. After inspecting the uterine cavity, the amniotic sac was opened with flexible endo-scissors and the hysteroscope was introduced. A gestationally appropriate fetus without signs of autolysis or anomalies was observed. An umbilical cord torsion was found as the probable cause of the miscarriage. To our [knowledge, this represents the first ever observed incident in which an umbilical cord complication was diagnosed as the probable cause of miscarriage in early gestation. Based on this case, we discuss the technical details, advantages and risks associated with the procedure which we have labelled,,abortion hysteroscopy".