ORIGINAL RESEARCH article
Front. Reprod. Health
Sec. Gynecology
Volume 7 - 2025 | doi: 10.3389/frph.2025.1602451
This article is part of the Research TopicInnovations and Early-Career Research in Gynecology 2024-2025View all 3 articles
Efficacy of Estradiol-Dydrogesterone and Auto-Crosslinked Hyaluronan Gel in Preventing Intrauterine Adhesions Following Missed Miscarriage Curettage: A Retrospective Cohort Study
Provisionally accepted
- 1Shanghai Putuo Maternity and Clild Health Center, Shanghai, China
- 2Shanghai Municipal Center for Disease Control and Prevention (SCDC), Shanghai, China
- 3Huashan Hospital, Fudan University, Shanghai, China
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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.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.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).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.
Keywords: Missed miscarriage, Intrauterine adhesions, estradiol-dydrogesterone, auto-crosslinked hyaluronan gel, Curettage
Received: 29 Mar 2025; Accepted: 27 Jun 2025.
Copyright: © 2025 Huilin, Mengyun, Lin, Jingfang and Long. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xue Long, Huashan Hospital, Fudan University, Shanghai, China
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