Autologous platelet-rich gel activated by calcium gluconate for postoperative endometrial repair in moderate-to-severe intrauterine adhesion: a retrospective preliminary evaluation of efficacy

Background This study aimed to investigate the effect of calcium gluconate–activated autologous platelet-rich gel (APG) on endometrial repair in patients with moderate-to-severe intrauterine adhesion (IUA). Methods In this study, 60 patients with moderate-to-severe IUA who were undergoing hysteroscopic transcervical resection of adhesion surgery were recruited and grouped based on whether they underwent APG treatment (APG group) or not (non-APG group; n = 30 each). Hysteroscopy examination and transvaginal ultrasonography were performed after surgery to evaluate adhesion recurrence and endometrial thickness. Simultaneously, patients self-recorded the menstrual volume using a menstrual diary. Results There was no significant difference in baseline characteristics, preoperative uterine adhesion grade, endometrial thickness, or menstrual pattern between the APG and non-APG groups ( p > 0.05). After treatment, compared with the non-APG group, the postoperative adhesion recurrence rate (13.3% vs. 36.7%) and adhesion grades (75% mild and 25% moderate vs. 72.7% mild and 27.3% moderate) were significantly decreased in the APG group ( p = 0.039). The endometrium thickness in the APG group was greater than that in the non-APG group (6.29 ± 0.24 mm vs. 5.10 ± 0.16 mm, p = 0.000), and the endometrial thickness increment was substantially higher in the APG group than that in the non-APG group (2.82 ± 0.17 mm vs. 1.84 ± 0.12 mm, p = 0.000). Furthermore, more participants in the APG group experienced significant recovery in menstrual volume at 3 months after surgery ( p = 0.031), and participants from the APG group maintained improved menstrual volume 6 months after surgery ( p = 0.029). Multivariate analysis confirmed the beneficial effect of APG in promoting endometrial repair. Conclusion Calcium gluconate–activated autologous platelet-rich gel has the potential to reduce postoperative recurrence and improve menstrual properties in patients with moderate-to-severe IUA.