Intrauterine application of Hyaluronic Gel reduces adhesions after dilation and curettage for miscarriage

Intrauterine application of auto-crosslinked hyaluronic acid (ACP) gel after dilatation and curettage(D&C) for miscarriage in women with a history of at least one previous D&C reduces the incidence of intrauterine adhesions (IUAs) by nearly 57%, reports results of study published in recent issue of Journal Fertility &Sterility.

Termination of pregnancy is the most common obstetric procedure performed worldwide. Approximately 15-20% of clinically confirmed pregnancy end in miscarriage. According to a review published in European Journal of Contraception and Health Care 1 in 3 women will have at least one pregnancy terminated in her reproductive life span.

It is known that intrauterine adhesions form after D&C, but the exact prevalence is not known.

The current multicentric, patient and assessors blinded prospective trial called as Preventionof Adhesions Post Abortion (PAPA) study is the largest randomized trial conducted so far evaluating the effect of application of ACP gel.

It recruited 152 women who had suffered miscarriage before 14 weeks of pregnancy. The subjects also had previous history of either one miscarriage or Termination of pregnancy.

Women either received only D&C or D&C plus ACP gel. All women were scheduled for a follow-up diagnostic hysteroscopy at 8-12 weeks. 

IUA were observed in 13% of women who received ACP gel as compared to 30% women who did not receive the ACP gel. (RR= .43)

The authors concluded that use of ACP gel reduces the incidence of IUA by 57% in the specific subgroup of women undergoing D&C for miscarriage with a history of at least one D&C.

A Cochrane review have earlier concluded that additional studies are needed to study the effectiveness of other antiadhesive therapies for improving reproductive outcomes in infertile women treated by operative hysteroscopy.

The authors call for need of larger studies to confirm the current findings and evaluate the long term reproductive benefits (live-birth, pregnancy, and miscarriage rates) of decreasing the risk of adhesions formation.