TITLE:
Therapeutic Use of Hyaluronidase in Obstetrics
AUTHORS:
Dana Sawan, Barbara Hersant
KEYWORDS:
Hyaluronidase, Cervical Ripening, Perineal Tear, Perineal Trauma, Hyaluronic Acid, Episiotomy
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.11,
November
23,
2021
ABSTRACT: Introduction: Hyaluronidases are a group of enzymes
that permit greater diffusion of fluid through the tissues. These enzymes have
the ability to reduce the viscosity of hyaluronic acid and increase cellular
membrane and blood vessel permeability. This review discusses the indication,
usage, effects, and safety of hyaluronidases in obstetrics. Materials and
Methods: MEDLINE/ PubMed
and the Cochrane Library were searched using the following terms: (“hyaluronidase” [Title/Abstract]) OR
(“hyaluronidases” [Title/Abstract]) AND (“therapeutic use”
[Title/Abstract]) OR (“therapeutic uses” [Title/Abstract]) OR (“perineal
trauma” [Title/Abstract]) OR (“perineal tear” [Title/Abstract]) OR (“cervical
ripening” [Title/Abstract]). Results: This review included four randomized
controlled trials (RCT) that randomized a total of 642 pregnant women and two
interventional non-RCTs that included a total of 2824 pregnant women. The data
from two RCTs suggested that the incidence of perineal trauma was significantly
lower in the intervention (perineal hyaluronidase injection in stage two of
labor) than the control group (no intervention). However, both groups did not
differ significantly in the incidence of first- and second-degree tears.
Similarly, no significant difference in the incidence of episiotomy was found between both groups. In one interventional
non-RCT, the administration of intracervical hyaluronidase was
associated with a statistically significant acceleration and shortening of
labor by approximately 1.95 hours after the injection of intracervical
hyaluronidase. However, it had no effect on uterine contractions or the
duration of stages two and three labor. Conclusions: While it is safe,
clinicians should consider patient acceptance and the effectiveness of
hyaluronidase compared to conventional less invasive methods.