{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T13:57:23Z","timestamp":1771855043316,"version":"3.50.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Reprod. Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Curettage is a common treatment for missed abortion (MA). However, intrauterine adhesions (IUA) are a major postoperative problem that can lead to infertility and menstrual abnormalities. This study aimed to evaluate the effectiveness of estradiol-dydrogesterone (ED), auto-crosslinked hyaluronan (AH) gel, and their combination in preventing IUA following MA curettage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study was conducted between June 2022 and December 2023. A total of 284 women following MA curettage were included, with 265 completing follow-up assessments. Participants were divided into four groups: (1) ED group (oral estradiol-dydrogesterone therapy), (2) AH group (intrauterine AH gel application), (3) ED\u2009+\u2009AH group (combination therapy), and (4) control group (no intervention). IUA diagnosis was confirmed via hysteroscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of IUA was significantly lower in the intervention groups compared to the control group (<jats:italic>p<\/jats:italic>\u2009=\u20090.001). The IUA rates were 7.94% in the ED group, 6.15% in the AH group, 5.71% in the ED\u2009+\u2009AH group, and 23.88% in the control group. Logistic regression analysis identified a significant reduction in IUA risk for patients receiving ED (OR\u2009=\u20090.17, <jats:italic>p<\/jats:italic>\u2009=\u20090.005), AH (OR\u2009=\u20090.13, <jats:italic>p<\/jats:italic>\u2009=\u20090.002), and ED\u2009+\u2009AH (OR\u2009=\u20090.15, <jats:italic>p<\/jats:italic>\u2009=\u20090.005) compared to the control group. Additionally, a history of three or more miscarriages was associated with a higher risk of IUA (OR\u2009=\u20094.34, <jats:italic>p<\/jats:italic>\u2009=\u20090.027).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrates that prophylactic treatment with ED and\/or AH significantly reduces the incidence of IUA following curettage for MA. These findings underscore the importance of individualized endometrial repair and adhesion prevention strategies in preserving female reproductive health.<\/jats:p><\/jats:sec>","DOI":"10.3389\/frph.2025.1602451","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T05:26:44Z","timestamp":1752470804000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of estradiol-dydrogesterone and auto-crosslinked hyaluronan gel in preventing intrauterine adhesions following missed miscarriage curettage: a retrospective observational 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