Anti-adhesive gels in the prevention of intrauterine adhesions after spontaneous abortion and missed miscarriage

DOI

https://dx.doi.org/10.18565/aig.2026.135

Dikke G.B., Sukhanov A.A., Khalitov R.A.
1) F.I. Inozemtsev Academy of Medical Education, St. Petersburg, Russia; 2) Perinatal Medical Centre, Tyumen, Russia; 3) Tyumen State Medical University, Ministry of Health of Russia, Tyumen, Russia; 4) Abdera LLC, Tyumen, Russia

Intrauterine adhesions (IUАs) occur in one in five women after spontaneous abotion (19.1%), with an increased risk after repeated interventions for retained products of conception (32–40%). Hysteroscopic treatment of IUАs is effective, but the recurrence rate can reach 23.5%, and only half of patients become pregnant. Therefore, primary IUАs prophylaxis is a strategy of choice for reproductive-aged women who need uterine surgery and are interested in pregnancy.
Objective. To systematize data on methods for preventing IUAs after spontaneous abortion and missed miscarriage using modern anti-adhesive gels.
Materials and methods. The articles were searched by two independent researchers in the databases PubMed, Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and eLibrary using the MeSH terms over the past ten years (2016–2026). The analysis includes 67 publications and 5 guidelines from professional communities.
Results. Among the currently used anti-adhesive agents, namely gels based on hyaluronic acid (HA), combined preparations of HA and carboxymethylcellulose, and gels based on polyethylene glycol, the most well-studied is HA gel. It has shown a 56% reduction in the risk of IUAs after spontaneous abortion (OR=0.44, 95% CI: 0.29–0.67) and a 61% reduction in the risk of IUAs after missed miscarriage (OR=0.39, 95% CI: 0.21–0.72). There was a two-fold increase in the chances of achieving pregnancy compared with the absence of gel administration after surgical evacuation of gestational tissues. A comparable reduction in the risk of IUAs is observed when using other types of gels, but the effect on pregnancy is not reported. No side effects directly related to anti-adhesive agents have been reported. Using gels is economically rational due to the direct benefit of preventing procedures related to IUA treatment and the indirect benefit of preventing complications of subsequent pregnancy.
Conclusion. The use of anti-adhesive gel should become a routine standard during repeated intrauterine procedures for spontaneous abortion or after the first episode of missed miscarriage. The optimal strategy is a combination of vacuum aspiration, intraoperative gel administration, and subsequent dynamic ultrasound monitoring.

Authors’ contributions. Dikke G.B., Sukhanov A.A. – writing the article; Khalitov R.A. – developing the concept of the study, final approval of the version for publication.
Conflicts of interest. The authors report that there is no conflict of interest and ensure that the article is the original work of the authors.
Funding. The research was carried out at the authors’ own expense. The publication of the article was supported by Abdera LLC, Tyumen, Russia.
Use of generative artificial intelligence. The authors claim that they did not use artificial intelligence technologies when writing the article.
For citation: Dikke G.B., Sukhanov A.A., Khalitov R.A. Anti-adhesive gels in the prevention of
intrauterine adhesions after spontaneous abortion and missed miscarriage.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (5): 30-42 (in Russian)
https://dx.doi.org/10.18565/aig.2026.135

spontaneous abortion

missed miscarriage

intrauterine adhesions

Asherman’s syndrome

fibrosis

prevention

anti-adhesive gels

hyaluronic acid

Full text (in Russian)

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Received 23.04.2026

Accepted 05.05.2026

Galina B. Dikke, Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology with a Course of Reproductive Medicine, F.I. Inozemtsev Academy of Medical Education, 190013, Russia, St. Petersburg, Moskovskiy Ave., 22 Liter M, galadikke@yandex.ru, https://orcid.org/0000-0001-9524-8962
Anton A. Sukhanov, Dr. Med. Sci., Head of the Gynecology Department, Perinatal Medical Centre, 625002, Russia, Tyumen, Daudelnaya str., 1; Associate Professor, Department of Obstetrics and Gynecology, Tyumen State Medical University, Ministry of Health of Russia, 625013, Russia, Tyumen, Permyakov str., 10,
saa2505anton@yandex.ru, https://orcid.org/0000-0001-9092-9136
Rustam A. Khalitov, PhD, Medical Advisor, Abdera LLC, Rustamakhmatgaleevich@bk.ru, https://orcid.org/0009-0005-8737-6055
Corresponding author: Galina B. Dikke, galadikke@yandex.ru

Anti-adhesive gels in the prevention of intrauterine adhesions after spontaneous abortion and missed miscarriage

Dikke G.B., Sukhanov A.A., Khalitov R.A.

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