Effect of cervical priming with misoprostol on cervical entry in women undergoing vaginoscopic hysteroscopy for evaluation of abnormal uterine bleeding: a randomized controlled trial

Nandhini, B Deepa; Maurya, Dilip Kumar; Keepanasseril, Anish; Kubera, N S

doi:10.1007/s00404-018-4764-y

Cited by 5 publications

(16 citation statements)

References 19 publications

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“…The literature search yielded 807 records and 24 studies were suitable for systematic review, 18–22,24–42 of which one trial was added after screening the reference lists of included studies 41 . Nineteen studies provided data for meta‐analysis 18–22,24–28,30,34–40,42 …”

Section: Resultsmentioning

confidence: 99%

“…Controls where a vaginal examination was performed without administering an agent were counted as placebo for meta‐analysis purposes. The authors of only one study sent data suitable for the meta‐analysis of pain scores 39 …”

Section: Resultsmentioning

confidence: 99%

“…The authors of only one study sent data suitable for the metaanalysis of pain scores. 39 No study examined whether routine mechanical dilatation of the cervix before outpatient hysteroscopy reduced pain associated with hysteroscopy. Twenty-one studies compared the use of a cervical preparation (misoprostol, mifepristone, carboprost, dinoprostone) against a control (placebo, nil, phloroglucinol, bladder distension, dinoprostone, buscopan), [18][19][20][21][22][24][25][26][27][28][29]31,32,[34][35][36][38][39][40][41][42] three studies compared two different doses of the same cervical preparation (200 versus 400 lg misoprostol) 18,30,37 and one study compared two different timings of administration of the same cervical preparation (3 hours versus 12 hours pre-procedurally).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Impact on pain Meta-analysis of 11 studies, 18,19,24,28,[34][35][36][38][39][40]42 including 2653 women, showed that cervical preparation led to a statistically significant reduction in pain during outpatient hysteroscopy compared with placebo (SMD -0.67, 95% CI -1.05 to -0.29). Subgroup analysis according to study quality reduced, but failed to eliminate, the degree of inconsistency, lowering the I 2 value from 93 to 79% (Figure 1).…”

Section: Cervical Preparation Typementioning

confidence: 99%

“…Subgroup analysis according to study quality reduced, but failed to eliminate, the degree of inconsistency, lowering the I 2 value from 93 to 79% (Figure 1). Subgroup analysis according to the agent given showed that both misoprostol (eight studies, 18,19,28,34,35,38,39,42 881 women) and dinoprostone (one study, 40 100 women) significantly reduced mean pain scores during hysteroscopy with SMDs (95% CI) of -0.64 (-0.97 to -0.31) and -2.24 (-2.75 to -1.74), respectively (Figure 2). Although evidence was limited to one study each, mifepristone 24 (58 women) and carboprost 36 (1314 women) did not show a significant difference in intra-procedural pain when administered before hysteroscopy with SMDs (95% CI) of -0.13 (-0.65 to 0.38) and 0.09 (-0.02 to 0.20), respectively.…”

Section: Cervical Preparation Typementioning

confidence: 99%

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Cervical dilatation and preparation prior to outpatient hysteroscopy: a systematic review and meta‐analysis

Silva

Wilson

Carnegy

et al. 2020

BJOG

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Background There are uncertainties about the benefit of routine cervical preparation and/or cervical dilatation before outpatient hysteroscopy. Objective To determine if cervical preparation and/or routine mechanical dilatation reduces pain during outpatient hysteroscopy. Search strategy MEDLINE, EMBASE, CINAHL and CENTRAL were searched on 19 October 2020, using keywords ‘hysteroscopy’, ‘cervical preparation’, ‘cervical ripening’, ‘cervical dilatation’, ‘outpatient’, ‘office’ and/or ‘ambulatory’ and associated medical subject headings. Selection criteria Randomised controlled trials investigating the benefit of cervical preparation and/or cervical dilatation on pain in women undergoing outpatient hysteroscopy were included. Data collection and analysis Two independent reviewers selected eligible trials and extracted data on pain, feasibility, adverse events and satisfaction/acceptability for meta‐analysis. Main results The literature search yielded 807 records, of which 24 were included for review and 19 provided data for meta‐analysis. No trials investigated the role of routine mechanical cervical dilatation. Cervical preparation significantly reduced pain during outpatient hysteroscopy; standard mean difference (SMD) ‒0.67, 95% confidence interval (CI) ‒1.05 to ‒0.29. Feasibility also improved as priming provided significantly easier hysteroscopic entry (SMD 0.89, 95% CI 0.32–1.46), greater cervical dilatation (SMD 0.81, 95% CI 0.08–1.53) and shorter procedural times (SMD ‒0.51, 95% CI ‒0.88 to ‒0.13). Cervical preparation, however, incurred significantly more adverse effects, mainly comprising genital tract bleeding, abdominal pain and gastrointestinal symptoms (odds ratio 2.94, 95% CI 1.58–5.47). There were limited data regarding satisfaction, acceptability and complications. Conclusions Cervical preparation reduces pain and improves feasibility associated with outpatient hysteroscopy but increases the risk of adverse effects. Tweetable abstract Cervical preparation before outpatient hysteroscopy reduces pain, enhances feasibility but increases adverse effects.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Cervical Preparation Typementioning

confidence: 99%

Section: Cervical Preparation Typementioning

confidence: 99%

See 3 more Smart Citations

Cervical dilatation and preparation prior to outpatient hysteroscopy: a systematic review and meta‐analysis

Silva

Wilson

Carnegy

et al. 2020

BJOG

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Comparative efficacy of lidocaine–prilocaine cream and vaginal misoprostol in reducing pain during levonorgestrel intrauterine device insertion in women delivered only by cesarean delivery: A randomized controlled trial

Hashem

Mahmoud

Islam

et al. 2022

Intl J Gynecology & Obste

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ObjectiveTo compare efficacy of lidocaine–prilocaine (LP) cream versus misoprostol versus placebo before levonorgestrel‐releasing intrauterine device (LNG‐IUD) insertion.MethodsThis randomized controlled trial (RCT) was conducted in a tertiary referral hospital from April 30, 2020 to March 1, 2021 on 210 parous women willing to receive LNG‐IUD and delivered only by elective cesarean delivery (CD). Participants received 200 μg vaginal misoprostol or 5 ml of LP cream 5% or placebo 3 h before LNG‐IUS insertion. Primary outcome was pain during LNG‐IUD insertion, while secondary outcomes were pain 10 min post‐procedure, ease of insertion, patient satisfaction, insertion time, and drug side effects.ResultsPain during LNG‐IUS insertion was reduced in LP group and misoprostol group compared to placebo group (2.1 ± 1.0 vs 3.7 ± 1.6; p <0.001) and (2.3 ± 1.3 vs 3.7 ± 1.6; p <0.001), respectively. Ease of procedure and patient satisfaction were significantly higher in LP and misoprostol groups than placebo (P <0.001). Need for additional analgesia was significantly higher in placebo group than in the other two groups (P = 0.009). Adverse events were not significantly different between the three groups except vomiting and abdominal cramps, which were higher with misoprostol.ConclusionLP cream and 200 μg of vaginal misoprostol administration before LNG‐IUD insertion in women delivered only by elective CD effectively reduced pain during insertion and 10 min post‐procedure with easier insertions, high patient satisfaction, and tolerable side effects. Pain reduction with LP cream was clinically significant.

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Uterine cervical stenosis: from classification to advances in management. Overcoming the obstacles to access the uterine cavity

Vitale

Angelis

Corte

et al. 2023

Arch Gynecol Obstet

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Background To date hysteroscopy is the gold standard technique for the evaluation and management of intrauterine pathologies. The cervical canal represents the access route to the uterine cavity. The presence of cervical stenosis often makes entry into the uterine cavity difficult and occasionally impossible. Cervical stenosis has a multifactorial etiology. It is the result of adhesion processes that can lead to the narrowing or total obliteration of the cervical canal. Purpose In this review, we summarize the scientific evidence about cervical stenosis, aiming to identify the best strategy to overcome this challenging condition. Methods The literature review followed the scale for the quality assessment of narrative review articles (SANRA). All articles describing the hysteroscopic management of cervical stenosis were considered eligible. Only original papers that reported data on the topic were included. Results Various strategies have been proposed to address cervical stenosis, including surgical and non-surgical methods. Medical treatments such as the preprocedural use of cervical-ripening agents or osmotic dilators have been explored. Surgical options include the use of cervical dilators and hysteroscopic treatments. Conclusions Cervical stenosis can present challenges in achieving successful intrauterine procedures. Operative hysteroscopy has been shown to have the highest success rate, particularly in cases of severe cervical stenosis, and is currently considered the gold standard for managing this condition. Despite the availability of miniaturized instruments that have made the management of cervical stenosis more feasible, it remains a complex task, even for experienced hysteroscopists.

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Effect of cervical priming with misoprostol on cervical entry in women undergoing vaginoscopic hysteroscopy for evaluation of abnormal uterine bleeding: a randomized controlled trial

Cited by 5 publications

References 19 publications

Cervical dilatation and preparation prior to outpatient hysteroscopy: a systematic review and meta‐analysis

Cervical dilatation and preparation prior to outpatient hysteroscopy: a systematic review and meta‐analysis

Comparative efficacy of lidocaine–prilocaine cream and vaginal misoprostol in reducing pain during levonorgestrel intrauterine device insertion in women delivered only by cesarean delivery: A randomized controlled trial

Uterine cervical stenosis: from classification to advances in management. Overcoming the obstacles to access the uterine cavity

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