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

BACKGROUND

Intrauterine adhesions are a severe complication after miscarriage. Hyaluronic acid gel has been used to prevent intrauterine adhesions after miscarriage.

OBJECTIVE

To systematically evaluate the efficacy of adjuvant therapy with hyaluronic acid gel to prevent intrauterine adhesions after miscarriage.

SEARCH STRATEGY: The Cochrane Library, Embase and PubMed databases were searched for articles published before 31 July 2018 using the terms: ('hyaluronic acid gel' or 'gel') and ('dilatation and curettage' or 'D&C' or 'abortion' or 'miscarriage' or 'hysteroscopic') and ('intrauterine adhesions' or 'Asherman syndrome' or 'IUA' or 'endometrial injury' or 'intrauterine adhesion').

SELECTION CRITERIA: Randomized controlled trials of hyaluronic acid gel therapy after miscarriage.

DATA COLLECTION AND ANALYSIS: Four studies were included in the meta-analysis (625 patients in total). Dichotomous outcomes were expressed as relative risk (RR) with 95 % confidence intervals (CI). Continuous variables were expressed as standardized mean differences (SMD).

MAIN

RESULTS

Hyaluronic acid gel reduced the intrauterine adhesion scores after miscarriage (SMD -0.68, 95 % CI -1.08～-0.28; p = 0.0008) and the incidence of postoperative intrauterine adhesions after miscarriage (RR 0.44, 95 % CI 0.29～0.67; p = 0.0001). Subgroup analysis found that hyaluronic acid gel reduced the incidence of moderate and severe intrauterine adhesions after miscarriage (RR 0.18, 95 % CI: 0.07～0.47; p = 0.0004), but had no effect on the incidence of mild intrauterine adhesions (RR 0.77, 95 % CI 0.42～1.19; p = 0.19). Hyaluronic acid gel also improved the pregnancy rate after miscarriage (RR 1.94, 95 % CI 1.46～2.60; p < 0.00001).

CONCLUSION

Hyaluronic acid gel significantly reduced the incidence of moderate and severe intrauterine adhesions and significantly improved the pregnancy rate after miscarriage.