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

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

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective To examine whether intrauterine application of auto-crosslinked hyaluronic acid (ACP) gel, after dilatation and curettage (D&C), reduces the incidence of intrauterine adhesions (IUAs). Design Multicenter; women and assessors blinded prospective randomized trial. Setting University and university-affiliated teaching hospitals. Patient(s) A total of 152 women with a miscarriage of <14 weeks with at least one previous D&C for miscarriage or termination of pregnancy. Intervention(s) Women were randomly assigned to either D&C plus ACP gel (intervention group) or D&C alone (control group). A follow-up diagnostic hysteroscopy was scheduled 8–12 weeks after the D&C procedure. Main Outcome Measure(s) The primary outcome was the number of women with IUAs and the secondary outcome was the severity of IUAs. Result(s) Outcomes were available for 149 women: 77 in the intervention group and 72 in the control group. The IUAs were observed in 10 (13.0%) and 22 women (30.6%), respectively (relative risk, 0.43; 95% confidence interval 0.22–0.83). Mean adhesion score and the amount of moderate-to-severe IUAs were significantly lower in the intervention group according to the American Fertility Society (AFS) and European Society of Gynecological Endoscopy classifications systems of adhesions. Conclusion(s) Intrauterine application of ACP gel after D&C for miscarriage in women with at least one previous D&C seems to reduce the incidence and severity of IUAs but does not eliminate the process of adhesion formation completely. Future studies are needed to confirm our findings and to evaluate the effect of ACP gel on fertility and reproductive outcomes. Clinical Trial Registration Number NTR 3120.

Original languageEnglish
Pages (from-to)1223-1231.e3
JournalFertility and Sterility
Volume107
Issue number5
DOIs
Publication statusPublished - 1 May 2017

Cite this

@article{cded326639374598bff5feaf3d354550,
title = "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 = "Objective To examine whether intrauterine application of auto-crosslinked hyaluronic acid (ACP) gel, after dilatation and curettage (D&C), reduces the incidence of intrauterine adhesions (IUAs). Design Multicenter; women and assessors blinded prospective randomized trial. Setting University and university-affiliated teaching hospitals. Patient(s) A total of 152 women with a miscarriage of <14 weeks with at least one previous D&C for miscarriage or termination of pregnancy. Intervention(s) Women were randomly assigned to either D&C plus ACP gel (intervention group) or D&C alone (control group). A follow-up diagnostic hysteroscopy was scheduled 8–12 weeks after the D&C procedure. Main Outcome Measure(s) The primary outcome was the number of women with IUAs and the secondary outcome was the severity of IUAs. Result(s) Outcomes were available for 149 women: 77 in the intervention group and 72 in the control group. The IUAs were observed in 10 (13.0{\%}) and 22 women (30.6{\%}), respectively (relative risk, 0.43; 95{\%} confidence interval 0.22–0.83). Mean adhesion score and the amount of moderate-to-severe IUAs were significantly lower in the intervention group according to the American Fertility Society (AFS) and European Society of Gynecological Endoscopy classifications systems of adhesions. Conclusion(s) Intrauterine application of ACP gel after D&C for miscarriage in women with at least one previous D&C seems to reduce the incidence and severity of IUAs but does not eliminate the process of adhesion formation completely. Future studies are needed to confirm our findings and to evaluate the effect of ACP gel on fertility and reproductive outcomes. Clinical Trial Registration Number NTR 3120.",
keywords = "Asherman syndrome, dilatation and curettage, hyaluronic acid, Intrauterine adhesions, miscarriage",
author = "Hooker, {Angelo B.} and {de Leeuw}, Robert and {van de Ven}, {Peter M.} and Bakkum, {Erica A.} and Thurkow, {Andreas L.} and Vogel, {Niels E.A.} and {van Vliet}, {Huib A.A.M.} and Bongers, {Marlies Y.} and Emanuel, {Mark H.} and Verdonkschot, {Annelies E.M.} and Br{\"o}lmann, {Hans A.M.} and Huirne, {Judith A.F.}",
year = "2017",
month = "5",
day = "1",
doi = "10.1016/j.fertnstert.2017.02.113",
language = "English",
volume = "107",
pages = "1223--1231.e3",
journal = "Fertility and Sterility",
issn = "0015-0282",
publisher = "Elsevier Inc.",
number = "5",

}

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

In: Fertility and Sterility, Vol. 107, No. 5, 01.05.2017, p. 1223-1231.e3.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage

T2 - short-term outcomes of a multicenter, prospective randomized controlled trial

AU - Hooker, Angelo B.

AU - de Leeuw, Robert

AU - van de Ven, Peter M.

AU - Bakkum, Erica A.

AU - Thurkow, Andreas L.

AU - Vogel, Niels E.A.

AU - van Vliet, Huib A.A.M.

AU - Bongers, Marlies Y.

AU - Emanuel, Mark H.

AU - Verdonkschot, Annelies E.M.

AU - Brölmann, Hans A.M.

AU - Huirne, Judith A.F.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Objective To examine whether intrauterine application of auto-crosslinked hyaluronic acid (ACP) gel, after dilatation and curettage (D&C), reduces the incidence of intrauterine adhesions (IUAs). Design Multicenter; women and assessors blinded prospective randomized trial. Setting University and university-affiliated teaching hospitals. Patient(s) A total of 152 women with a miscarriage of <14 weeks with at least one previous D&C for miscarriage or termination of pregnancy. Intervention(s) Women were randomly assigned to either D&C plus ACP gel (intervention group) or D&C alone (control group). A follow-up diagnostic hysteroscopy was scheduled 8–12 weeks after the D&C procedure. Main Outcome Measure(s) The primary outcome was the number of women with IUAs and the secondary outcome was the severity of IUAs. Result(s) Outcomes were available for 149 women: 77 in the intervention group and 72 in the control group. The IUAs were observed in 10 (13.0%) and 22 women (30.6%), respectively (relative risk, 0.43; 95% confidence interval 0.22–0.83). Mean adhesion score and the amount of moderate-to-severe IUAs were significantly lower in the intervention group according to the American Fertility Society (AFS) and European Society of Gynecological Endoscopy classifications systems of adhesions. Conclusion(s) Intrauterine application of ACP gel after D&C for miscarriage in women with at least one previous D&C seems to reduce the incidence and severity of IUAs but does not eliminate the process of adhesion formation completely. Future studies are needed to confirm our findings and to evaluate the effect of ACP gel on fertility and reproductive outcomes. Clinical Trial Registration Number NTR 3120.

AB - Objective To examine whether intrauterine application of auto-crosslinked hyaluronic acid (ACP) gel, after dilatation and curettage (D&C), reduces the incidence of intrauterine adhesions (IUAs). Design Multicenter; women and assessors blinded prospective randomized trial. Setting University and university-affiliated teaching hospitals. Patient(s) A total of 152 women with a miscarriage of <14 weeks with at least one previous D&C for miscarriage or termination of pregnancy. Intervention(s) Women were randomly assigned to either D&C plus ACP gel (intervention group) or D&C alone (control group). A follow-up diagnostic hysteroscopy was scheduled 8–12 weeks after the D&C procedure. Main Outcome Measure(s) The primary outcome was the number of women with IUAs and the secondary outcome was the severity of IUAs. Result(s) Outcomes were available for 149 women: 77 in the intervention group and 72 in the control group. The IUAs were observed in 10 (13.0%) and 22 women (30.6%), respectively (relative risk, 0.43; 95% confidence interval 0.22–0.83). Mean adhesion score and the amount of moderate-to-severe IUAs were significantly lower in the intervention group according to the American Fertility Society (AFS) and European Society of Gynecological Endoscopy classifications systems of adhesions. Conclusion(s) Intrauterine application of ACP gel after D&C for miscarriage in women with at least one previous D&C seems to reduce the incidence and severity of IUAs but does not eliminate the process of adhesion formation completely. Future studies are needed to confirm our findings and to evaluate the effect of ACP gel on fertility and reproductive outcomes. Clinical Trial Registration Number NTR 3120.

KW - Asherman syndrome

KW - dilatation and curettage

KW - hyaluronic acid

KW - Intrauterine adhesions

KW - miscarriage

UR - http://www.scopus.com/inward/record.url?scp=85017092615&partnerID=8YFLogxK

U2 - 10.1016/j.fertnstert.2017.02.113

DO - 10.1016/j.fertnstert.2017.02.113

M3 - Article

VL - 107

SP - 1223-1231.e3

JO - Fertility and Sterility

JF - Fertility and Sterility

SN - 0015-0282

IS - 5

ER -