Meta‑analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations

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

doi:10.3892/etm.2020.8483

Cited by 21 publications

(26 citation statements)

References 27 publications

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“…The efficiency of the hyaluronic gel was independent to the type of procedure, these figures being as follows: abortion, hysteroscopy, primary disorders/diseases such as abortion, IUA, submucosal myoma, endometrial polyps or mediastinum uterus. Furthermore, the hyaluronic gel improved pregnancy rates [ 132 ].…”

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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“…HA can bind to a large number of water molecules improving tissue hydration, increasing cell resistance to mechanical damage, and reducing post-traumatic formation of granulation and fibrous tissue. Due to its unique biocompatibility and enzymatic biodegradation, HA is often used to prevent postoperative adhesions [69,70]. HA gel significantly reduces the frequency of IUA after intrauterine surgery, regardless of the type of intervention or the presence of primary diseases.…”

Section: Clinical Usage Of Antiadhesive Polymers To Prevent Aschermanmentioning

confidence: 99%

Biomimetics for treatment of endometrial pathologies: an overview

Konovalova¹,

Tsaregorodtseva²,

Полтавцева³

et al. 2020

CTT

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Secondary infertility among women in their childbearing age is one of sufficient problems in Russia. It is often caused by damage to the basal layer of endometrium when performing gynecological procedures, e.g., dilatation of uterine cavity, diagnostic curettage, cesarean section, uterine surgey, as well as consequences of complicated pregnancies. As a result, hypo-or hypermetriosis may develop, along with intrauterine adhesions (synechiae), leading to the development of Asherman's syndrome. Despite large amounts of medical data, there are no quite effective ways to treat secondary infertility. Currently, various biological polymers and composite materials based on biopolymers with incorporated active molecules, genetic substances, platelet-rich plasma, stem cells or microvesicles/exosomes of stem cells are used with some success for treatment of hypometriosis and Asherman's syndrome. Gel substances based on sodium hyaluronate, carboxymethylcellulose, polyethylene oxide, collagen and others are certified for clinical use. Biopolymer gels serve, on the one hand, as the materials separating the uterine walls (barrier function), and, on the other hand, they work as carriers of biologically active molecules and cells. Biomimetics can stimulate the regeneration and normalization of endometrium at different efficiency rates, thus promoting restoration of reproductive capacity. Biomimetic-based therapies are under investigation. The present review provides data on treatment efficiency of endometrial disorders by means of biotherapeutic approaches.

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“…These symptoms include abnormal uterine bleeding, amenorrhea, dysmenorrhea, infertility, abnormal placentation, and recurrent miscarriage [ 1 , 2 , 4 , 7 , 8 , 9 , 24 , 25 , 26 , 27 , 28 , 29 ]. As there is continuous progression in hysteroscopic surgeries and they are widely performed for the treatment of various kinds of intrauterine lesions, there is increased concern about IUA-associated morbidities and the subsequent significant impairment of reproductive performance in women of reproductive age [ 3 , 5 , 7 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. Among these surgeries, hysteroscopic myomectomy is one of the best examples, since it is considered as the best choice of therapy in the management of women with submucosal myomas [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is reported that in up to 62.5% of patients, IUA will recur after hysteroscopic adhesiolysis [ 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. Taken together, this suggests the urgent need to focus on the primary prevention of IUA after intrauterine surgeries [ 3 , 5 , 7 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. Several techniques have been proposed to prevent de novo IUA, which is postoperative adhesion without initial evidence of IUA at the same sites [ 66 ].…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, semi-solid agents can overcome the disadvantages of physical barriers. These materials include polyethylene oxide–sodium carboxymethylcellulose (PEO-NaCMC) gels and auto-crosslinked hyaluronic acid (ACHA) or hyaluronic acid (HA) gels, which have been proposed or investigated over the past few years [ 3 , 6 , 24 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 57 , 58 , 62 , 63 , 64 , 65 , 66 , 67 ]. ACHA and HA, in theory, show their effect on preventing the development of IUA based on their high affinity to the traumatic site of the postoperative endometrium [ 64 ].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Applying Hyaluronic Acid Gels in the Primary Prevention of Intrauterine Adhesion after Hysteroscopic Myomectomy: A Meta-Analysis of Randomized Controlled Trials

Chen

Chang

Yang

et al. 2020

Life

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Intrauterine adhesion (IUA), which mainly occurs after intrauterine surgery or an inflammatory process, is an important but often neglected condition in women of reproductive age. The presentation of IUA varies greatly, ranging from symptom-free to severe, with amenorrhea or infertility. With much advanced development of intrauterine instruments, more intrauterine diseases can be successfully cured by hysteroscopic surgery. Among these, submucosal myoma is one of the best examples. Submucosal myomas are often related to abnormal bleeding, anemia, and possible infertility or miscarriage. However, submucosal myoma after hysteroscopic myomectomy may be complicated by IUA in various grades of severity, and its incidence and prevalence might be nearly one-quarter to one-third of patients, suggesting an urgent need for efforts to decrease the risk of developing IUA after hysteroscopic myomectomy. Many strategies have been reported to be useful for this purpose, and intrauterine application of anti-adhesive gels, such as polyethylene oxide–sodium carboxymethylcellulose (PEO-NaCMC) or auto-crosslinked hyaluronic acid (ACHA), has become increasingly popular in routine clinical practice. This meta-analysis is aimed at investigating the effect of ACHA on the primary prevention of IUA formation after hysteroscopic myomectomy. A pooled analysis of three studies (hysteroscopic surgeries for fibroids, polyps, and septum) including 242 women showed that using PEO-NaCMC or ACHA gel decreased the IUA rate with an odds ratio (OR) of 0.364 (95% confidence interval (CI) 0.189–0.703, p = 0.03). Pooled analysis of two studies that limited the use of ACHA in 119 women showed that the application of ACHA gel for the primary prevention of IUA in patients after hysteroscopic myomectomy led to a statistically significant reduction of the development of IUA postoperatively (OR 0.285, 95% CI 0.116–0.701, p = 0.006). All of this suggests that the use of ACHA gel in patients after hysteroscopic myomectomy could significantly reduce de novo IUA, although more evidence is needed.

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Meta‑analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations

Cited by 21 publications

References 27 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?

Biomimetics for treatment of endometrial pathologies: an overview

Efficacy of Applying Hyaluronic Acid Gels in the Primary Prevention of Intrauterine Adhesion after Hysteroscopic Myomectomy: A Meta-Analysis of Randomized Controlled Trials

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