• Angelo B Hooker, Robert A de Leeuw, TwiskJos W RJWRDepartment of Epidemiology and Biostatistics, Amsterdam University Medical Center, Vrije Universiteit Medical Center, Amsterdam, the Netherlands., BrölmannHans A MHAMDepartment of Obstetrics and Gynecology, Amsterdam University Medical Center, Vrije Universiteit Medical Center, Amsterdam, the Netherlands., and Judith A F Huirne.
• Department of Obstetrics and Gynecology, Zaans Medical Center, Zaandam, the Netherlands; Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Vrije Universiteit Medical Center, Amsterdam, the Netherlands. Electronic address: hooker.a@zaansmc.n.
• Fertil. Steril. 2020 Sep 1; 114 (3): 601-609.

ObjectiveTo study whether intrauterine application of auto-crosslinked polymers of hyaluronic acid (ACP) gel after dilation and curettage (D&C) improves reproductive outcomes.DesignFollow-up of a prospective randomized trial.SettingUniversity 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 NumberNTR 3120.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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