Vaginal Misoprostol Prior to Diagnostic Hysteroscopy in Patients of Reproductive Age: A Randomized Clinical Trial

Valente, Emanuelle Pessa; Amorim, Melânia Maria Ramos; Costa, André dos Santos; Miranda, Danielle Veríssimo de

doi:10.1016/j.jmig.2008.04.001

Cited by 21 publications

(16 citation statements)

References 31 publications

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“…The data presented in our study are in accordance with previous studies, which showed that the use of misoprostol before outpatient or inpatient hysteroscopy is often accompanied with unwanted adverse effects [20,23]. Valente et al [23] reported adverse effects in the form of vaginal bleeding (55%), nausea (15%), diarrhea (5%), and fever (5%) after vaginal administration of misoprostol 6 h prior to office hysteroscopy.…”

Section: Misoprostol Prior To Office Hysteroscopysupporting

confidence: 91%

“…The study found that vaginal misoprostol was not effective in reducing the pain perceived during office hysteroscopy [23]. On the contrary, Esin et al [24] reported that sublingual misoprostol (200 µg administered 2 h before the procedure) was more effective than lidocaine spray in minimizing the pain perceived by premenopausal women during office hysteroscopy.…”

Section: Misoprostol Prior To Office Hysteroscopymentioning

confidence: 99%

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Misoprostol Prior to Diagnostic Office Hysteroscopy in the Subgroup of Patients with No Risk Factors for Cervical Stenosis: A Randomized Double Blind Placebo-Controlled Trial

Fouda

Elsetohy

Elshaer

et al. 2017

Gynecol Obstet Invest

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Aims: To assess the effectiveness of vaginal misoprostol in minimizing the pain perceived by patients with no risk factors for cervical stenosis (i.e., parous women of reproductive age who have no history of cesarean section or cervical surgery) during diagnostic office hysteroscopy. Methods: A total of 100 patients with no risk factors for cervical stenosis were randomized to the misoprostol group (n = 50) or the placebo group (n = 50). In the misoprostol group, 2 misoprostol tablets (400 µg) were administered vaginally 12 h before office hysteroscopy. In the placebo group, 2 placebo tablets were administered. The patients rated the intensity of pain perceived during the procedure and at 30 min after the procedure with the use of a 100 mm visual analog scale (VAS). The hysteroscopists also scored the difficulty of hysteroscope insertion into the uterine cavity with the use of a 100 mm VAS. Results: There were no significant differences between both groups in the VAS pain scores during or at 30 min after the procedure (28.3 ± 13.58 vs. 30.42 ± 15.13 and 11.1 ± 10.23 vs. 13.32 ± 11.12, respectively). The difficulty of hysteroscope insertion into the uterine cavity was comparable between both groups. Conclusion: Misoprostol administration prior to diagnostic office hysteroscopy appears to have no beneficial role in the subgroup of patients with no risk factors for cervical stenosis.

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Section: Misoprostol Prior To Office Hysteroscopysupporting

confidence: 91%

Section: Misoprostol Prior To Office Hysteroscopymentioning

confidence: 99%

Misoprostol Prior to Diagnostic Office Hysteroscopy in the Subgroup of Patients with No Risk Factors for Cervical Stenosis: A Randomized Double Blind Placebo-Controlled Trial

Fouda

Elsetohy

Elshaer

et al. 2017

Gynecol Obstet Invest

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“…Six studies were considered eligible for inclusion in the review (Figure 1). 11–16 The inter‐rater reliability for the study selection was very good (κ = 0.86). Four of the six papers were deemed to be of high quality 12,13,15,16 (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…An attempt was made to contact authors for their primary data but unfortunately insufficient data were received to be able to perform any analysis. The incidence of gastrointestinal adverse effects were reported by two studies, 15,16 bleeding by four studies, 11,14–16 cervical lacerations by three studies 11,13,16 and failed procedures by three studies 12,13,15 . These results were meta‐analysed.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies examined the use of misoprostol 400 μg given vaginally before the hysteroscopy to premenopausal women. The drugs were administered 4 hours before in one of the studies 11 and 6 hours before in the other 15 . The low‐quality study 11 found that pain during cervical dilatation was significantly reduced after the use of prostaglandin compared with placebo ( P < 0.05); however, the other, high‐quality study 15 found no significant reduction in pain during the hysteroscopy with the use of misoprostol ( P = 0.72) (Table 2).…”

Section: Resultsmentioning

confidence: 99%

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Does cervical preparation before outpatient hysteroscopy reduce women’s pain experience? A systematic review

Cooper

Smith

Khan³

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Background Studies examining the use of pharmaceutical (prostaglandins, antiprogestogens) and mechanical (osmotic dilators) dilatation of the cervix before hysteroscopy under general anaesthesia have produced conflicting results regarding their effect on cervical dilatation and trauma during the procedure.Objective To compare the effect on pain and need for cervical dilatation of various methods of cervical preparation before outpatient hysteroscopy.Search strategy MEDLINE, EMBASE and CINAHL were searched using a combination of the keywords 'hysteroscopy', 'vaginoscopy', 'cervical ripening', 'laminaria', 'progest*', 'prostaglandin', 'oestrogen' 'cervical preparation' and their associated Medical Subject Headings The Cochrane Library was searched using the keywords 'hysteroscopy' and 'cervical'. There were no limits or filters placed on the searches.Selection criteria Randomised controlled trials that examined women undergoing outpatient hysteroscopy, where the intervention was the use of cervical preparation versus a control or placebo and the outcome was pain assessment.Data collection and analysis Two reviewers independently selected trials. Data were extracted on pain, the effect on dilatation, adverse effects, trauma and feasibility. Data regarding pain and cervical dilatation were unsuitable for meta-analysis. Meta-analyses were performed for adverse effects and feasibility using the random effects models to calculate the Peto odds ratio.Results From 585 abstracts, six studies were selected for inclusion in the systematic review. The results suggest that there may be a benefit of using prostaglandins for postmenopausal women; however, there is no high-quality evidence that giving misoprostol before outpatient hysteroscopy reduces the pain experienced by women of reproductive age. There is some evidence that prostaglandins reduce the force and requirement for dilatation of the cervix beyond 5 mm.Author's conclusions There is no evidence to recommend the routine administration of mifepristone or misoprostol to women before outpatient hysteroscopy. Cervical priming with vaginal prostaglandins may be considered in postmenopausal women if using hysteroscopic systems >5 mm in diameter.

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Office Operative Hysteroscopy: Polyp and Submucosal Fibroid Removal

Orady

Aslanova

2014

Office-Based Gynecologic Surgical Procedures

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Vaginal Misoprostol Prior to Diagnostic Hysteroscopy in Patients of Reproductive Age: A Randomized Clinical Trial

Cited by 21 publications

References 31 publications

Misoprostol Prior to Diagnostic Office Hysteroscopy in the Subgroup of Patients with No Risk Factors for Cervical Stenosis: A Randomized Double Blind Placebo-Controlled Trial

Misoprostol Prior to Diagnostic Office Hysteroscopy in the Subgroup of Patients with No Risk Factors for Cervical Stenosis: A Randomized Double Blind Placebo-Controlled Trial

Does cervical preparation before outpatient hysteroscopy reduce women’s pain experience? A systematic review

Office Operative Hysteroscopy: Polyp and Submucosal Fibroid Removal

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