Objective To investigate the predictive value of transvaginal ultrasound (TVUS) combined with serum β-human chorionic gonadotropin (β-hCG) and uterine artery blood flow parameters in the conservative treatment and surgical intervention decisionmaking of incomplete abortion. Methods A total of 92 patients with incomplete abortion who attended Zhenping Chinese Medicine Hospital from February 2023 to February 2026 were retrospectively selected. According to the final clinical treatment, they were divided into conservative treatment successful group (n＝51) and surgical intervention group (n＝41). The differences of each index between the two groups were compared, and the predictive efficacy of single and combined indexes on surgical intervention demand was analyzed by receiver operator characteristic (ROC) curve. Results The maximum diameter of residual tissue, proportion of Adler grade Ⅲ, serum β -hCG level and PI, RI of uterine artery in the surgical intervention group were significantly higher than those in the conservative successful group (all P＜0.05). The ROC curve showed that the combined prediction of TVUS residual diameter, β-hCG and uterine artery RI was 0.912 (95%CI: 0.861?0.963), the optimal cutoff value was when the prediction probability was greater than 0.52, and the sensitivity and specificity were 86.7% and 89.4%, respectively, which were better than any single index. Conclusion TVUS combined with serum β-hCG and uterine artery blood flow parameters can effectively distinguish high-risk cases of incomplete abortion requiring surgical intervention, and provide objective basis for clinical individualized decision-making.