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

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; I-2 = 64%) and adhesion score (standard mean difference = -2.90; 95% CI -4.61 to -1.49; p < 0.00001; I-2 = 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; I-2 = 0%), but not those deemed mild (RR 0.86; 95% CI 0.62-1.21; p = 0.39; I-2 = 3%) or severe (RR 0.33; 95% CI 0.03-3.09; p = 0.33; I-2 = 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. (C) 2018 S. Karger AG, Basel