title: [Prevention of intrauterine adhesion with auto-crosslinked hyaluronic acid gel: a prospective, randomized, controlled clinical study].
abstract: OBJECTIVE
  To evaluate the efficacy and safety of auto-crosslinked hyaluronic acid (HA) gel for preventing intrauterine adhesion (IUA) after hysteroscopic adhesiolysis.
  
  
  METHODS
  A prospective, randomized, double blinded and controlled clinical trial (level I) was performed. According to American Fertility Society (AFS) scoring system, 120 patients (treatment group: 60 cases, control group: 60 cases) with moderate to severe IUA were enrolled. Upon completion of adhesiolysis, a Foley balloon catheter was first introduced into the uterine cavity and then 3 ml of auto-crosslinked HA gel for patients in the treatment group; patients in the control group, however, only received Foley balloon catheter. Second-look hysteroscopic examination was performed to all patients at 3 months postoperatively for evaluation of IUA. Primary endpoint was the reduction rate of IUA at 3 months after surgery. The secondary endpoints include total AFS score, score of each individual AFS category.
  
  
  RESULTS
  At 3 months after surgery, auto-crosslinked HA gel resulted in significantly higher effective rate for reduction of adhesion, the effective rate were 76% (42/55) and 48% (27/56) respectively (P = 0.000 9); the total AFS score of treatment group was 2.1 ± 1.1, and significantly lower than that of control group (3.7 ± 2.5, P = 0.000 8). Application of auto-crosslinked HA gel after surgery significantly enhanced the improvement for each individual patient with regard to their adhesive type and menstrual pattern (P = 0.037 8, P = 0.000 4). The treatment group had significantly lower proportion of patients with moderate to severe adhesive stages than that of control group [13% (7/55) versus 38% (21/56), P = 0.000 6]. No adverse events and complications were observed.
  
  
  CONCLUSIONS
  Auto-crosslinked HA gel coule be able to reduce IUA, decrease adhesion severity, and improve menopause postoperatively. This absorbable auto-crosslinked HA gel is proposed as a barrier for preventing IUA after intrauterine procedures.
authors: Department of Obstetrics and Gynecology, the Third Xiangya Hospital of Central South University, Changsha 410013, China.
authors: Songshu
authors: S
authors: Xiao
authors: Yajun
authors: Y
authors: Wan
authors: Fangjun
authors: F
authors: Zou
authors: Mingzhu
authors: M
authors: Ye
authors: Henan
authors: H
authors: Deng
authors: Jiezhi
authors: J
authors: Ma
authors: Yingying
authors: Y
authors: Wei
authors: Chen
authors: C
authors: Tan
authors: Email: xueminxy3@163.com.
authors: Min
authors: M
authors: Xue
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D015907:Hysteroscopy / Q000009:adverse effects*; D011134:Polysaccharides / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000209:etiology / Q000517:prevention & control*
chemical_list: D011134:Polysaccharides; C431864:auto-cross-linked polysaccharide; D006820:Hyaluronic Acid