Efficacy of estradiol-dydrogesterone and auto-crosslinked hyaluronan gel in preventing intrauterine adhesions following missed miscarriage curettage: a retrospective observational study.

Objective: Curettage is a common treatment for missed abortion (MA). However, intrauterine adhesions (IUA) are a major postoperative problem that can lead to infertility and menstrual abnormalities. This study aimed to evaluate the effectiveness of estradiol-dydrogesterone (ED), auto-crosslinked hyaluronan (AH) gel, and their combination in preventing IUA following MA curettage.

Methods: A retrospective cohort study was conducted between June 2022 and December 2023. A total of 284 women following MA curettage were included, with 265 completing follow-up assessments. Participants were divided into four groups: (1) ED group (oral estradiol-dydrogesterone therapy), (2) AH group (intrauterine AH gel application), (3) ED + AH group (combination therapy), and (4) control group (no intervention). IUA diagnosis was confirmed via hysteroscopy.

Results: The incidence of IUA was significantly lower in the intervention groups compared to the control group (p = 0.001). The IUA rates were 7.94% in the ED group, 6.15% in the AH group, 5.71% in the ED + AH group, and 23.88% in the control group. Logistic regression analysis identified a significant reduction in IUA risk for patients receiving ED (OR = 0.17, p = 0.005), AH (OR = 0.13, p = 0.002), and ED + AH (OR = 0.15, p = 0.005) compared to the control group. Additionally, a history of three or more miscarriages was associated with a higher risk of IUA (OR = 4.34, p = 0.027).

Conclusion: This study demonstrates that prophylactic treatment with ED and/or AH significantly reduces the incidence of IUA following curettage for MA. These findings underscore the importance of individualized endometrial repair and adhesion prevention strategies in preserving female reproductive health.