Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial

Hooker, Angelo B.; Leeuw, Robert de; Ven, Peter M. van de; Bakkum, Erica A.; Thurkow, Andreas L.; Vogel, Niels E. A.; Vliet, Huib A.A.M. van; Bongers, Marlies Y.; Emanuel, Mark Hans; Verdonkschot, Annelies E.M.; Brölmann, Hans A.M.; Huirne, Judith A.F.

doi:10.1016/j.fertnstert.2017.02.113

Cited by 90 publications

(64 citation statements)

References 30 publications

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“…A total of seven were included in the final analysis after screening ( Fig. 1) (10,(13)(14)(15)(16)(17)(18). All 7 studies compared the efficacies of using hyaluronic acid gel as an adjuvant therapy (treatment group) against a control group (without the use of hyaluronic acid gel) after an intrauterine operation.…”

Section: Resultsmentioning

confidence: 99%

“…From these patients, 455 had been treated with hyaluronic acid gel postoperatively and 497 were controls. Among the 7 studies, 3 used common abortive procedures such as intrauterine operations (14,15,17) and 4 were performed using hysteroscopy (10,13,16,18). A total of six studies were performed using direct injection with the gel (10,16,18) and one used a temporary adhesion barrier, which hydrated into a gel within 24-48 h of administration into the patient (17).…”

Section: Resultsmentioning

confidence: 99%

“…A total of six studies were performed using direct injection with the gel (10,16,18) and one used a temporary adhesion barrier, which hydrated into a gel within 24-48 h of administration into the patient (17). There were no statistically significant differences in baseline parameters between the treatment and control groups, as presented in Table I (10,(13)(14)(15)(16)(17)(18). The results of the quality assessment of the included studies are presented in Fig.…”

Section: Resultsmentioning

confidence: 99%

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

Zheng¹,

Xin

He³

et al. 2020

Exp Ther Med

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Intrauterine adhesion (IUA) is a severe complication that occurs following abortion, and hyaluronic acid gel has been used to prevent IUA following intrauterine operation. The present study aimed to systematically evaluate the efficacy of hyaluronic acid gel in preventing IUA following intrauterine operation. In the current study, a literature search was performed using PubMed, Cochrane Library and EMbase databases for randomized controlled clinical trials that used hyaluronic acid gel as an adjuvant therapy following intrauterine operation. The terms 'hyaluronic acid', 'intrauterine adhesions', 'Asherman's syndrome', 'IUA', 'dilatation and curettage', 'abortion' and 'hysteroscopic' were used to search for articles published online before July 31, 2018. RevMan 5.3 software was used to analyze the indicators of uterine cavity adhesion formation and pregnancy rates following intrauterine operation. A total of seven randomized controlled clinical studies were included, consisting of 952 patients who underwent intrauterine operation. The meta-analysis indicated that the use of hyaluronic acid gel reduced the incidence of IUA [relative risk (RR)=0.42; 95% confidence interval (CI)=0.30-0.57; P<0.001] and the score for IUA after an intrauterine operation (mean difference=-1.29; 95%=-1.73 to-0.84; P<0.001). A subgroup analysis revealed that the preventive effect of hyaluronic acid gel on IUA was not affected by the type of intrauterine operation, namely abortion (RR=0.40; 95% CI=0.26-0.62; P<0.001) and hysteroscopy (RR=0.44; 95% CI=0.28-0.68; P<0.001). The preventive effect of hyaluronic acid gel on IUA was also not affected by primary disorders/diseases including the following: Abortion (RR=0.48; 95% CI=0.29-0.78; P=0.003); IUA (RR=0.38; 95% CI=0.21-0.67; P<0.001) and submucosal myoma of the uterus, endometrial polyps or mediastinum uterus (RR=0.40; 95% CI=0.18-0.90; P=0.03). Hyaluronic acid gel improved pregnancy rates after intrauterine operations (RR=1.94; 95% CI=1.46-2.60; P<0.001). In conclusion, hyaluronic acid gel was indicated to significantly reduce the incidence of IUA following intrauterine operation, regardless of the type of intrauterine operation or the presence of primary diseases. Treatment with hyaluronic acid gel was also revealed to increase pregnancy rates following intrauterine operation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Zheng¹,

Xin

He³

et al. 2020

Exp Ther Med

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“…Only one trial, conducted by Hooker et al [9], reported complications associated with use of hyaluronic acid gel. The major complications were patient discomfort and uterine perforation, with no statistically significant differences between the 2 groups.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Hyaluronic Acid Gel for the Prevention of Intrauterine Adhesion: A Meta-Analysis of Randomized Clinical Trials

Liu

et al. 2018

Gynecol Obstet Invest

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Background: The aim of this study is to assess the clinical effectiveness and safety of hyaluronic acid gel for the prevention of postoperative intrauterine adhesions (IUAs). Methods: PubMed, Cochrane Library, Embase and ClinicalTrials.gov databases were searched for randomized controlled trials. Results: Six RCTs with a total of 564 patients met the inclusion criteria. The meta-analysis showed that, compared to no other treatment method, hyaluronic acid gel significantly reduced the rate of any IUA (risk ratio [RR] 0.68; 95% CI 0.53–0.86; p = 0.03; I² = 64%) and adhesion score (standard mean difference = –2.90; 95% CI –4.61 to –1.49; p < 0.00001; I² = 98%) following intraperitoneal or intrauterine surgery. Treatment lowered the rate of IUAs classified as moderate (RR 0.26; 95% CI 0.13–0.52; p = 0.13; I² = 0%), but not those deemed mild (RR 0.86; 95% CI 0.62–1.21; p = 0.39; I² = 3%) or severe (RR 0.33; 95% CI 0.03–3.09; p = 0.33; I² = 0). Compliance with hyaluronic acid gel treatment was low. Conclusion: Hyaluronic acid gel can prevent IUAs, particularly those with moderate severity and a lower adhesion score.

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“…dilatation and curettage), resection of endometrial polyps, and resection of the uterine cavity septum. 3,4 In addition, cesarean delivery, pelvic inflammatory disease, endometrial tuberculosis, and uterine artery embolism can also cause intrauterine adhesion. 5,6 Hysteroscopic adhesiolysis and adjuvant therapies-including hormones, intrauterine devices, intrauterine balloons, gels, and early secondary hysteroscopy-have been moderately successful in treating intrauterine adhesions.…”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of the use of amniotic membrane to prevent recurrence of intrauterine adhesion after hysteroscopic adhesiolysis

Zheng

Zhu

Liu

et al. 2018

Intl J Gynecology & Obste

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Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial

Abstract: NTR 3120.

Cited by 90 publications

References 30 publications

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

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

Efficacy and Safety of Hyaluronic Acid Gel for the Prevention of Intrauterine Adhesion: A Meta-Analysis of Randomized Clinical Trials

Meta‐analysis of the use of amniotic membrane to prevent recurrence of intrauterine adhesion after hysteroscopic adhesiolysis

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