Analysis of factors related to intrauterine adhesions after hysteroscopic surgery versus curettage in the treatment of early missed abortion

Yang Xiao; He Yumei; Shen Huanhuan; Yang Lijing; Li Yin

doi:10.3760/j.issn.1673-4777.2026.03.021

Abstract：Objective To analyze the factors related to the occurrence of intrauterine adhesions after hysteroscopic surgery versus curettage in the treatment of early missed abortion.Methods A total of 60 patients with missed abortion admitted to the Third People's Hospital of Yunnan Province from January 2024 to June 2025 were selected as the research objects.They were divided into group A and group B by random number table method,with 30 cases in each group.Group A underwent routine curettage,and group B underwent hysteroscopic removal of gestational products.The surgical indicators,postoperative human chorionic gonadotropin(HCG)levels,menstrual recovery,endometrial thickness,pulsatility index(PI)and resistance index(RI)of subendometrial blood flow,and intrauterine adhesions were compared between the two groups.Results The operation time,intraoperative blood loss,hospital stay,and postoperative vaginal bleeding time in group B were significantly shorter/less than those in group A[(10.2±2.1)min vs(14.7±2.0)min,(35.3±5.6)mlvs(46.6±5.3)ml,(5.1±0.6)d vs(6.3±0.7)d,(6.0±0.9)d vs(7.8±1.0)d](t=8.227,8.005,6.481,7.272,all P＜0.001).With the passage of time,the HCG values in both groups showed a downward trend,and the HCG values in group B at 24 h,1 week,and 1 month after surgery were significantly lower than those in group A(all P＜0.05).The menstrual recovery time and the proportion of reduced menstrual volume in group B were significantly shorter/lower than those in group A(all P＜0.05).At 3 months after surgery,the endometrial thicknesses in both groups were significantly greater than those at 1 month after surgery,and the endometrial thicknesses in group B at 1 and 3 months after surgery were significantly greater than those in group A[(5.8±0.8)mm vs(4.4±0.7)mm,(8.0±0.9)mm vs(6.2±0.8)mm](t=7.859,8.094,all P＜0.001).At 3 months after menstrual resumption,the PI and RI values in both groups were significantly lower than those at 1 month after menstrual resumption,and those in group B were significantly lower than those in group A[(1.52±0.29)vs(2.17±0.41),(0.62±0.06)vs(0.75±0.09)](t=7.089,6.583,all P＜0.001).The incidence of intrauterine adhesions in group B was significantly lower than that in group A[6.7％(2/30)vs 26.7％(8/30)](x2=4.320,P=0.038).Conclusion Compared with routine curettage,hysteroscopic surgery can reduce the occurrence of intrauterine adhesions after early missed abortion,promote endometrial repair,improve uterine hemodynamics,and is conducive to protecting patients' reproductive function.It can be used as the preferred surgical method for missed abortion.