Alginate Carboxymethylcellulose Hyaluronic Acid for Preventing Intrauterine Adhesion after Vacuum Aspiration for First-Trimester Abortion: A Prospective, Randomized Controlled Trial

Objectives: This trial examined the effectiveness of intrauterine alginate carboxymethylcellulose hyaluronic acid-(ACH) gel application after vacuum aspiration as a treatment in first-trimester abortion to reduce formation and severity of intrauterine adhesions (IUAs). Materials and Methods: This prospective, single-blinded, randomized controlled trial included 68 pregnant women, at a gestational age of ≤13 weeks, who were diagnosed with abortion without previous histories of curettage, and who underwent termination of pregnancy by vacuum aspiration. After vacuum aspiration, the participants were assigned randomly to an intervention group (with ACH-gel application; n = 34) or a control group (no ACH gel application; n = 34). All participants were scheduled for office hysteroscopy 8-12 weeks after vacuum aspiration to evaluate the IUAs. Results: Six participants did not undergo hysteroscopy. Therefore, outcomes were available for only 62 patients - 32 in the intervention group and 30 in the control group. IUAs were noted in 17 patients (27.42%), with 5 participants (8.06%) in the intervention group and 12 participants (19.35%) in the control group (relative risk = 0.39; 95% confidence interval: 0.16-0.98; p = 0.04). The severity of IUAs was not significantly different between both groups (p = 0.61). Conclusions: The application of ACH gel after vacuum aspiration in patients who have miscarriages without previous histories of curettage can reduce IUA formation significantly.