Dilation and curettage (D&C) is a very frequently performed diagnostic or therapeutic procedure. Formation of intrauterine adhesions is a complication associated with this procedure. The rate of intrauterine adhesions in women following dilation and curettage for miscarriage can be reduced by intrauterine instillation of hyaluronic acid gel, according to results of the multicenter HYFACO study from France published in the October 2022 issue of The American Journal of Obstetrics and Gynecology.¹

The study designed as a prospective, open-label randomized trial enrolled 343 patients, who suffered a miscarriage between 7^th and 14^th weeks of gestation, underwent D&C and desired another pregnancy. The follow-up period was for 2 years. The study participants were randomized to undergo D&C with intrauterine instillation of hyaluronic acid gel or just D&C alone (controls) in a 1:1 ratio. The rate of formation of intrauterine adhesions during a follow-up hysteroscopy 6-8 weeks post-procedure was the primary outcome of the study.

Out of the 343 women who underwent D&C, 278 had a follow-up hysteroscopy. The rate of intrauterine adhesions was 9.1% among women who received hyaluronic acid gel after the D&C procedure compared to 18.4% in women who just had D&C alone.

Surveys were also conducted at 6 months and 1 year after the procedure to assess the fertility of the participants. A total of 110 women answered the surveys. One year after the D&C, the two groups had comparable pregnancy rates; 57.4% in the control group and nearly 70% in the intervention group. The overall pregnancy rate was 64.5%.

Intrauterine adhesions are associated with  infertility, menstrual irregularities and recurrent pregnancy loss. Hysteroscopic adhesiolysis often does not resolve these issues. Hence, it is important to prevent formation of intrauterine adhesions. This study, which demonstrated that intrauterine instillation of hyaluronic acid gel reduces the rate of intrauterine adhesions in women who underwent D&C for miscarriage, seems to show a way out of this conundrum.

Reference

1. Sroussi J, et al. Does hyaluronic acid gel reduce intrauterine adhesions after dilation and curettage in women with miscarriage? A multicentric randomized controlled trial (HYFACO Study). Am J Obstet Gynecol. 2022 Oct;227(4):597.e1-597.e8. doi: 10.1016/j.ajog.2022.05.064.