Pregnancy and neonatal outcomes 42 months after application of hyaluronic acid gel following dilation and curettage for miscarriage in women who have experienced at least one previous curettage: follow-up of a randomized controlled trial

Significantly more ongoing pregnancies and live births were reported after intrauterine application of auto-crosslinked polymers of hyaluronic acid following dilation and curettage (D&C) after miscarriage in women with at least one previous D&C.

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VOLUME 114, ISSUE 3, P601-609

Authors:

Angelo B. Hooker, M.D., Robert A. de Leeuw, Ph.D., Jos W.R. Twisk, Ph.D., Hans A.M. Brölmann, Ph.D., Judith A.F. Huirne, Ph.D.

Abstract:

Objective

To study whether intrauterine application of auto-crosslinked polymers of hyaluronic acid (ACP) gel after dilation and curettage (D&C) improves reproductive outcomes.

Design

Follow-up of a prospective randomized trial.

Setting

University and university-affiliated teaching hospitals.

Patient(s)

Women with a miscarriage at <14 weeks’ gestation with at least one previous D&C were randomized to D&C plus ACP gel (intervention) or D&C alone (control). A hysteroscopy was performed after 8–12 weeks, and if intrauterine adhesion (IUAs) were encountered, adhesiolysis was executed.

Intervention(s)

Participants received a questionnaire 30 months after treatment.

Main Outcome Measure(s)

Ongoing pregnancy and outcome of subsequent pregnancies.

Result(s)

Ongoing pregnancies were recorded in 74.6% (50/67) of the intervention group versus 67.2% (43/64) of the control group, and in, respectively, 94.3% (50/53) versus 71.7% (43/60) in the women wishing to conceive. The median times to conception leading to a live birth were, respectively, 21.9 versus 36.1 months. Reduced menstrual blood loss was reported in 7.5% (5/67) versus 20.3% (13/64) and dysmenorrhea in 14.9% (10/67) versus 34.4% (22/64), respectively.

Conclusion(s)

Application of ACP gel following D&C performed after miscarriage seems to have a favorable effect on subsequent reproductive outcomes in women with at least one previous D&C. Given the fact that the study was not powered for reproductive outcomes, the data should be interpreted with caution. The effect may be underestimated due to routine removal of IUAs.

Dutch Clinical Trial Registry Number

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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