Meta-analysis of the use of hyaluronic acid gel to prevent intrauterine adhesions after miscarriage

Zheng, Fangfang; Xin, Xin; He, Fei; Cui, Yuechong

doi:10.1016/j.ejogrb.2019.10.018

Cited by 34 publications

(17 citation statements)

References 19 publications

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“…Another meta-analysis conducted by Fei et al [ 134 ] brought some interesting results. Hyaluronic acid gel reduced IUA scores after miscarriage and the incidence of post-operative IUAs after miscarriage.…”

Section: Introduction Our Current Knowledge About the Asherman Symentioning

confidence: 99%

Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome—Where Are We after One Hundred and Twenty-Six Years?

et al. 2020

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Asherman syndrome is a multifaceted condition describing the partial or complete removal of the uterine cavity and/or cervical canal. It is a highly debatable topic because of its pronounced influence on both reproductive outcomes and gynaecologic symptoms. The latest reports demonstrated that trauma to the endometrium is the main cause of intrauterine adhesion formation. Left untreated, such adhesions gradually lead to a range of repercussions ranging from mild to severe. Considering the lack of non-invasive approaches, the advent of hysteroscopy has revolutionized the entire field, being otherwise considered the most efficient tool offering new directions and amplifying the chances of treating the Asherman syndrome.

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Section: Introduction Our Current Knowledge About the Asherman Symentioning

confidence: 99%

Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome—Where Are We after One Hundred and Twenty-Six Years?

et al. 2020

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“…Another earlier meta-analysis was conducted to evaluate the effectiveness of the use of HA gel to prevent IUA after miscarriage [ 123 ]. The results of a total of four studies [ 109 , 114 , 128 , 129 ] enrolling 625 patients showed that HA gel significantly reduced the incidence of IUA after miscarriage with a relative risk (RR) of 0.44 and a 95% confidence interval (95% CI) ranging from 0.29 to 0.67 ( p = 0.0001), and it also significantly reduced the severity of IUA after miscarriage, with a standardized mean difference (SMD) of −0.68 and a 95% CI ranging from −1.08 to −0.28 in the IUA scores ( p = 0.0008) [ 123 ]. In agreement with our aforementioned findings, this meta-analysis also found that HA gel significantly reduced the incidence of moderate and severe IUA after miscarriage (RR 0.18, 95% CI 0.07–0.47, p = 0.0004), but seemed to have no effect on the reduced incidence of mild-form IUA (RR 0.77, 95% CI 0.42–1.19, p = 0.19) [ 123 ].…”

Section: Primary Prevention Of Intrauterine Adhesion (Iua)mentioning

confidence: 99%

“…The results of a total of four studies [ 109 , 114 , 128 , 129 ] enrolling 625 patients showed that HA gel significantly reduced the incidence of IUA after miscarriage with a relative risk (RR) of 0.44 and a 95% confidence interval (95% CI) ranging from 0.29 to 0.67 ( p = 0.0001), and it also significantly reduced the severity of IUA after miscarriage, with a standardized mean difference (SMD) of −0.68 and a 95% CI ranging from −1.08 to −0.28 in the IUA scores ( p = 0.0008) [ 123 ]. In agreement with our aforementioned findings, this meta-analysis also found that HA gel significantly reduced the incidence of moderate and severe IUA after miscarriage (RR 0.18, 95% CI 0.07–0.47, p = 0.0004), but seemed to have no effect on the reduced incidence of mild-form IUA (RR 0.77, 95% CI 0.42–1.19, p = 0.19) [ 123 ]. Yan and Xu also found that HA corresponded to a relatively high preventive effect against severe IUAs, as using HA was superior to no treatment (logOR (odds ratio) −2.44, 95% CI from −3.95 to −0.92), and furthermore, the IUA scores in the HA treatment group showed an SMD of −1.25 (95% CI from −1.52 to −0.97) compared to those in the no-treatment group [ 24 ].…”

Section: Primary Prevention Of Intrauterine Adhesion (Iua)mentioning

confidence: 99%

Focus on the Primary Prevention of Intrauterine Adhesions: Current Concept and Vision

Lee

Liu

Chen

et al. 2021

IJMS

108

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Intrauterine adhesion (IUA), and its severe form Asherman syndrome (Asherman’s syndrome), is a mysterious disease, often accompanied with severe clinical problems contributing to a significant impairment of reproductive function, such as menstrual disturbance (amenorrhea), infertility or recurrent pregnancy loss. Among these, its correlated infertility may be one of the most challenging problems. Although there are many etiologies for the development of IUA, uterine instrumentation is the main cause of IUA. Additionally, more complicated intrauterine surgeries can be performed by advanced technology, further increasing the risk of IUA. Strategies attempting to minimize the risk and reducing its severity are urgently needed. The current review will expand the level of our knowledge required to face the troublesome disease of IUA. It is separated into six sections, addressing the introduction of the normal cyclic endometrial repairing process and its abruption causing the formation of IUA; the etiology and prevalence of IUA; the diagnosis of IUA; the classification of IUA; the pathophysiology of IUA; and the primary prevention of IUA, including (1) delicate surgical techniques, such as the use of surgical instruments, energy systems, and pre-hysteroscopic management, (2) barrier methods, such as gels, intrauterine devices, intrauterine balloons, as well as membrane structures containing hyaluronate–carboxymethylcellulose or polyethylene oxide–sodium carboxymethylcellulose as anti-adhesive barrier.

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“…HA could decrease the incidence of adhesions by downregulating the inflammatory response and promoting the vascularization process, thus emerging as one of the significant gel-based physical barriers for the IUA treatment [ 35 ]. Treatment with HA gel can reduce the incidence of IUA and increase pregnancy rates following an intrauterine operation [ 36 , 37 ]. Meta-analysis of clinical trials showed that HA gel could prevent IUAs, particularly those with moderate severity and a lower adhesion score.…”

Section: Hyaluronic Acid In Endometrial Regenerative Medicinementioning

confidence: 99%

Recent developments in bio-scaffold materials as delivery strategies for therapeutics for endometrium regeneration

Zhao

et al. 2021

Materials Today Bio

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Intrauterine adhesions (IUAs) refer to the repair disorder after endometrial injury and may lead to uterine infertility, recurrent miscarriage, abnormal menstrual bleeding, and other obstetric complications. It is a pressing public health issue among women of childbearing age. Presently, there are limited clinical treatments for IUA, and there is no sufficient evidence that these treatment modalities can effectively promote regeneration after severe endometrial injury or improve pregnancy outcome. The inhibitory pathological micro-environment is the main factor hindering the repair of endometrial damaged tissues. To address this, tissue engineering and regenerative medicine have been achieving promising developments. Particularly, biomaterials have been used to load stem cells or therapeutic factors or construct an in situ delivery system as a treatment strategy for endometrial injury repair. This article comprehensively discusses the characteristics of various bio-scaffold materials and their application as stem cell or therapeutic factor delivery systems constructed for uterine tissue regeneration.

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Meta-analysis of the use of hyaluronic acid gel to prevent intrauterine adhesions after miscarriage

Cited by 34 publications

References 19 publications

Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome—Where Are We after One Hundred and Twenty-Six Years?

Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome—Where Are We after One Hundred and Twenty-Six Years?

Focus on the Primary Prevention of Intrauterine Adhesions: Current Concept and Vision

Recent developments in bio-scaffold materials as delivery strategies for therapeutics for endometrium regeneration

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