Does hyaluronic acid gel reduce intrauterine adhesions after dilation and curettage in women with miscarriage? A Multicentric randomized controlled trial (HYFACO Study).

Abstract

BACKGROUND:

Miscarriage is a frequent problem that requires dilation and curettage in 30% of cases. This routine surgery may lead to intrauterine adhesions and severe infertility. Hyaluronic acid gel is known to reduce intrauterine adhesions after hysteroscopic surgery.

OBJECTIVE:

This study aimed to evaluate the rate of intrauterine adhesions after dilation and curettage for miscarriage with and without hyaluronic acid gel.

STUDY DESIGN:

This was a multicentric (9 hospitals in France), prospective, open-label randomized trial. Patients who had a miscarriage between weeks 7 and 14 of gestation, required dilation and curettage, and wanted another pregnancy were eligible for the study. Women were randomly assigned in a 1:1 ratio to surgery alone (control group) or surgery with intrauterine instillation of hyaluronic acid gel (gel group). An office hysteroscopy was planned at 6 to 8 weeks after surgery. The primary endpoint was the rate of intrauterine adhesions during this office follow-up hysteroscopy. Two different follow-up fertility surveys were sent at 6 months and 1 year after the end of the intervention, respectively.

RESULTS:

Among the 343 patients who had curettage, 278 had hysteroscopy. After multiple imputation, the rate of intrauterine adhesions was lower in the gel group than in the control group (9.1% vs 18.4%, respectively; P=.0171). Among the 110 responders to the surveys, the overall pregnancy rate at 12 months after surgery was 64.5% (71/110), and similar in both groups (57.4% [27/47] in the control group vs 69.8% [44/63] in the gel group; P=.1789).

CONCLUSION:

Intrauterine instillation of hyaluronic acid gel reduces the rate of intrauterine adhesions in women treated with dilation and curettage for miscarriage.

• Authors: Jérémy Sroussi, Antoine Bourret, Anne-Gaëlle Pourcelot, Thibault Thubert, Magali Lesavre, Guillaume Legendre, Sophie Tuffet, Alexandra Rousseau, Jean-Louis Benifla, HYFACO group
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 227 Issue 4 Pg. 597.e1-597.e8 (10 2022) ISSN: 1097-6868 [Electronic] United States
• PMID: 35667420 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Chemical References

• Gels
• Hyaluronic Acid

Topics

• Abortion, Spontaneous (epidemiology, surgery)
• Curettage
• Dilatation
• Female
• Gels
• Humans
• Hyaluronic Acid (therapeutic use)
• Hysteroscopy (adverse effects)
• Pregnancy
• Prospective Studies
• Tissue Adhesions (prevention & control, surgery)
• Uterine Diseases (surgery)