Role of intrauterine instillation of autologous platelet-rich plasma in the prevention of intrauterine adhesions following surgical abortion: an interventional randomized controlled trial

Objective: The incidence of intrauterine adhesions (IUA) following surgical abortion is reportedly approximately 19%. It is associated with adverse reproductive outcomes. Therefore, there has been a search for preventive modalities that can facilitate endometrial regeneration and decrease the disease burden. This study aimed to estimate the incidence of IUAs after surgical abortion following intrauterine infusion of autologous platelet-rich plasma using the American Fertility Society (AFS) scoring system through hysteroscopy. Methods: A randomized controlled trial was conducted, and all women, aged 18–45 years, with a period of gestation (POG) <20 weeks who underwent surgical abortion were included in the study. The participants were randomized into two groups (33 in each); the intervention group received surgical abortion + platelet-rich plasma (PRP) instillation and the control group underwent surgical abortion. All participants underwent follow-up hysteroscopy at 8 weeks to assess for the occurrence of IUA. The IUA was scored according to AFS scoring. Results: The demographic and clinical characteristics of the study population were similar between the groups. The mean age was 28.09 ± 5.329 years and 26.94 ± 4.092 years in the intervention and control group, respectively. The mean adhesion score was significantly higher in the control group than in the intervention group (1.87 ± 2.71 vs. 0.43 ± 1.28; P = 0.01). The overall incidence of IUAs was 29.3% and 10% ( P = 0.007) in the control and intervention group, respectively. Multivariate logistic regression analysis showed that POG >12 weeks (odds ratio [ OR ] = 8.5), prior abortions >2 ( OR = 5.3), and prior suction evacuation ( OR = 2.15) were significantly associated with the development of IUA. A predictive model was constructed using various risk factors with good sensitivity (79%) and specificity (88.2%) for identifying women at risk of developing IUA. Conclusion: PRP instillation after surgical abortion reduced the primary incidence of IUA.