LAUSR

To the Editor, We read the original article by Chung et al. with great interest.1 They describe the utilisation of ultrasound‐guided manual vacuum aspiration (USG‐MVA) for treating early pregnancy loss. The authors should be congratulated for performing a study on this important topic. Nevertheless, there are several issues which warrant further clarification The authors state ‘this is the first reported study with the use of routine USG during MVA’. However, MVA was first introduced in 1973 by the International Pregnancy Advisory Services as an alternative method for electric vacuum aspiration for the management of pregnancy loss. Since then, MVA has been widely used for a variety of applications such as termination of early pregnancy, management of missed and incomplete abortions and endometrial sampling. In addition, USG‐MVA was recently evaluated for removal of retained products of conception (RPOCs) after normal vaginal delivery.2 Therefore, the authors should be more cautious in their claim for novelty. Secondly, the authors report no complication encountered in their current study. However, due to its small sample size (n = 37), it was not powered to evaluate the safety of the procedure as its associated complication rate is relatively low and thus a much larger study is required in this regard.3 We strongly agree with the authors that careful casebycase selection is the key factor to facilitate successful USG‐MVA outcomes and believe that this approach should be further evaluated by larger prospective randomised controlled trials in order to better delineate its efficacy. Lastly, the authors report a culture failure rate for chromosomal analysis of only 5.7%; this leads to the striking success rate of 94.3% which is no less than phenomenal. As in most early pregnancy losses, clinical symptoms of miscarriage may occur relatively late following the loss of viability; such conceptions may therefore fail to grow in culture. There are many aspects that may interfere with success of this cytogenetic analysis such as absence of dividing cells, overgrowth of maternal cells (which cause contamination of the specimen) and microbial contamination. Practically speaking, the karyotype may be useful but has several limitations and pitfalls that must be carefully considered with an overall success rate of genetic material analyses reported to be 50–60%,4,5 even when paraffin blocks are used for further array of comparative genomic hybridisation.