Experience of intrauterine application of anti-adhesive gel based on hyaluronic acid in the prevention of Asherman's syndrome in patients with the pathology of the uterine cavity and severe forms of endometriosis

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Abstract


Introduction. One of the leading problems of modern reproductive surgery is treatment of adhesive disease, and in turn, prevention of intrauterine adhesions after intrauterine interventions is of particular interest.

Purpose: to evaluate the effectiveness and safety of anti-adhesive gel “Antiadgesin” for intrauterine use in patients with a combination of pathology of the uterine cavity and severe forms of endometriosis.

Materials and methods. The study included 24 patients aged 23 to 39 years with a combination of pathology of the uterine cavity and severe forms of genital endometriosis. The main group consisted of 12 patients to whom the anti-adhesive gel “Antiadhesin” was applied at the end of the laparoscopic and hysteroscopic stages on the region of the ovaries, pelvic peritoneum in the areas of separation of the adhesions, and also inside the uterine cavity. The comparison group included 12 patients who received 0.9% sodium chloride solution (5 ml) on the surgical area. Patients of both groups underwent treatment with gonadotropin-releasing hormone agonists (GnRH-a) 3.75 mg for 4 months after the operation. We performed gynecological ultrasound 4 weeks after operation, 4 weeks after the last injection of GnRH-a, and after the first menstrual bleeding. Assessment of the state of the uterine cavity, diagnosis of intrauterine synechia was performed by hydrosonography.

Results. The duration of the operation, the amount of intraoperative blood loss did not differ significantly between the groups. In all patients, no complications of the postoperative period, no allergic or inflammatory reactions associated with the use of “Antiadhesin” were detected. The duration the uterine bleeding after the operation did not differ significantly between the groups. In 2 patients of the comparison group hydrosonography confirmed the adhesive pathology of the uterine cavity. In the main group there were not identified any signs of intrauterine adhesions by ultrasound. Within 12 months after the treatment, pregnancy occurred in 50% of the patients in the main group and in 33.3% of the patients in the comparison group.

Conclusion. The results of the study showed that the introduction of the anti-adhesive gel “Antiadgesin” in the uterine cavity after hysteroresectoscopy is a safe and effective method for preventing the formation of intrauterine synechia.


Arseniy S. Molotkov

Research Institute of Obstetrics, Gynecology and Reproduction named after D.O. Ott; St. Petersburg University

Author for correspondence.
Email: arseny.molotkov@gmail.com

Russian Federation, Saint Petersburg; Saint Petersburg

PHD, Senior Researcher of the Department of Operative Gynecology with an operation unit

Eduard N. Popov

Research Institute of Obstetrics, Gynecology and Reproduction named after D.O. Ott

Email: edvardpopov@mail.ru

Russian Federation, Saint Petersburg

MD, Head of the Department of Operative Gynecology with an operation unit

Dmitriy S. Sudakov

Research Institute of Obstetrics, Gynecology and Reproduction named after D.O. Ott; North-Western State Medical University named after I.I. Mechnikov

Email: suddakovv@yandex.ru

Russian Federation, Saint Petersburg; Saint Petersburg

PHD, Assistant Professor of the Department of obstetrics and gynecology

Tatyana A. Aivazyan

Research Institute of Obstetrics, Gynecology and Reproduction named after D.O. Ott; St. Petersburg University

Email: aivazyan1944@gmail.com

Russian Federation, Saint Petersburg; Saint Petersburg

PHD, Associate Professor of the Department of Obstetrics, Gynecology and Reproduction

Lyudmila A. Alexandrova

Research Institute of Obstetrics, Gynecology and Reproduction named after D.O. Ott; St. Petersburg University

Email: l.a.alexandrova@spb.ru

Russian Federation, Saint Petersburg; Saint Petersburg

PHD, Associate Professor of the Department of Obstetrics, Gynecology and Reproduction

Yulia R. Dymarskaya

North-Western State Medical University named after I.I. Mechnikov

Email: julia_dym@mail.ru

Russian Federation, Saint Petersburg

PHD, Assistant Professor of the Department of obstetrics and gynecology

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Copyright (c) 2017 Molotkov A.S., Popov E.N., Sudakov D.S., Aivazyan T.A., Alexandrova L.A., Dymarskaya Y.R.

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