Abstract: To utilize Embryoscopy to obtain accurate information for genetic counseling by visualizing the fetus to evaluate structural abnormalities and to obtain direct chorionic villi biopsies for chromosome analysis in patients with missed abortion after documented fetal heart activity. Retrospective chart review. Embryoscopy was performed on nine patients with missed abortion after documented loss of fetal heart activity. Embryoscopy was performed in conjunction with direct chorionic villi biopsies and suction dilatage and curetage. Using saline as the distending medium, a 3 mm hysteroscope was inserted into the gestational sac to evaluate the fetus for structural abnormalities and to obtain directed chorionic villi biopsies. Fetal growth and development was evaluated then compared to normal fetal growth and developement which correlated with the fetal gestational age. Products of conception, labeled as chorionic villi, were sent for chromosome analysis. Of the nine patients studied, all nine fetuses were structurally abnormal when compared to expected embryonic development at the documented gestational days. Chromosome analysis of the embryoscopic directed biopsies revealed four abnormalities, which included: 69 XXX, 47 XX+9, 47 XX+11, and 70 XXY+22. The remaining five tissue cultures from products of conception yielded karyoptype 46 XX, which were suspected maternal tissue contamination. With the proximity of chorionic villi to the maternal circulation, inevitable mixing of maternal and fetal cells occur. Viable maternal cells rather than abnormal or nonviable fetal cells are more likely to grow in the culture medium. Up to 90% of products of conception sent for chromosome analysis return as 46 XX. (1) When products of conception are sent for chromosome analysis, maternal cells rather than fetal cells are often karyotyped. Chromsome analyses reporting 46 XX for products of conception will have an attached disclaimer that states the analysis could be contaminated by maternal cells. Inaccurate information is reported regarding fetal genetics, leading to faulty genetic counseling for future pregnancies. Embryoscopy allows direct observation of fetal structures and allows direct chorionic villi biopsies to provide more accurate fetal genetic information. Improvement in fetal genetic assessment provides better data for more acurate genetic counseling. Embryoscopy with direct observation of fetal structures and direct chorionic villi biopsies is more accuratein detecting genetic abnormalities in pregnancies which have ended in missed abortion after previous documentation of fetal heart activity. In addition to helping couples progress through their grief, accurate fetal assessment and karyotyping should aid genetic counseling of those couples seeking future conception options. More studies are needed to more precisely define the role of embryoscopy in genetic counseling. (1) American Journal of Obstretrics and Gynecology. 2001July;185(1):198-203.