Using American Fertility Society classification of intrauterine adhesions, the efficacy of a new crosslinked hyaluronan gel in reducing intrauterine adhesion formation after dilatation and curettage for delayed miscarriage in women without previous dilatation and curettage was examined.
Study Objectives: To evaluate the efficacy of a new crosslinked hyaluronan gel in reducing intrauterine adhesions formation after dilatation and curettage. Design: Randomized controlled trial. Settings: Six hospitals for maternal and child health care in China. Patients: Three hundred women undergoing dilatation and curettage for delayed miscarriage without previous dilatation and curettage. Interventions: Women were randomly assigned into either dilatation and curettage alone group or dilatation and curettage plus new crosslinked hyaluronan gel application group with 1:1 allocation. Measurements and Outcomes: All patients were evaluated using American Fertility Society classification of IUAs during the follow-up diagnostic hysteroscopy, scheduled 3 months after dilatation and curettage procedure. The primary outcome was the number of women with IUAs, and the secondary outcome was the adhesion scores and the severity of IUAs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
300
At the end of the dilatation and curettage, new crosslinked hyaluronan gel was applied to the uterine cavity.
Incidence of intrauterine adhesion
The number of women with intrauterine adhesion
Time frame: 3 months after dilatation and curettage
The adhesion scores of extent of uterine cavity involved
Evaluated according to American Fertility Society classification of intrauterine adhesion during the follow-up diagnostic hysteroscopy: 1 point (\<1/3 cavity with adhesion), 2 points (1/3-2/3 cavity with adhesion) and 4 points (\>2/3 cavity with adhesion), high values represent worse outcome
Time frame: 3 months after dilatation and curettage
The adhesion scores of type of adhesion
Evaluated according to American Fertility Society classification of intrauterine adhesion during the follow-up diagnostic hysteroscopy: 1 point (filmy adhesion), 2 points (filmy \& dense adhesion) and 4 points (dense adhesion), high values represent worse outcome
Time frame: 3 months after dilatation and curettage
The adhesion scores of menstrual pattern
Evaluated according to American Fertility Society classification of intrauterine adhesion during the follow-up diagnostic hysteroscopy: 0 point (normal), 2 points (hypomenorrhea) and 4 points (amenorrhea), high values represent worse outcome
Time frame: 3 months after dilatation and curettage
Cumulative adhesion score
The summed score of the adhesion scores of extent of uterine cavity involved, type of adhesion and menstrual pattern; range: 1-12 points, high values represent worse outcome
Time frame: 3 months after dilatation and curettage
Severity
Graded according to cumulative adhesion score: Stage I (mild)(1-4 points), Stage II (moderate)(5-8 points) and Stage III (severe)(9-12 points).
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Time frame: 3 months after dilatation and curettage