A randomised placebo-controlled trial of vaginal misoprostol for cervical priming before hysteroscopy in postmenopausal women

Fung, T

doi:10.1016/s1470-0328(02)01054-6

Cited by 17 publications

(35 citation statements)

References 3 publications

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“…In the present study, further subgroup analyses revealed that intrauterine lidocaine plus misoprostol reduced overall pain during, immediately following, and 20 min following the procedure in perimenopausal but not in postmenopausal participants. In 2 randomized trials, either 400 μg of oral misoprostol 12 h before procedure or 800 μg of vaginal misoprostol 5 h before the procedure was used in postmenopausal women, and no differences in baseline cervical dilation or operative time were found between misoprostol and placebo groups [23,24]. Tissues are more fibrotic and less elastic and hormone receptor sensitivity in the cervix is decreased in postmenopausal women, and this may cause a difference in the effect of drugs on prostaglandins.…”

Section: Discussionmentioning

confidence: 99%

Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy

Güney

Oral

Mungan

2007

Intl J Gynecology & Obste

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Section: Discussionmentioning

confidence: 99%

Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy

Güney

Oral

Mungan

2007

Intl J Gynecology & Obste

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“…Judging cervical width in millimetres preoperatively with dilators used in clinical practice is a normal method of assessing the effect of cervical ripening 12–17,19–27. Less commonly, preoperative ripening is assessed by measuring cumulative dilatation force using a cervical tonometer 11,13,16.…”

Section: Introductionmentioning

confidence: 99%

Comparison of self‐administered vaginal misoprostol versus placebo for cervical ripening prior to operative hysteroscopy using a sequential trial design*

Oppegaard

Bi²,

Istre

et al. 2008

BJOG

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Objective To compare the impact of 1000 micrograms of self-administered vaginal misoprostol versus self-administered vaginal placebo at home on preoperative cervical ripening in both premenopausal and postmenopausal women before operative hysteroscopy.Design Two separate but identical parallel, randomised, double-blind, placebo-controlled sequential trials, one in premenopausal women and one in postmenopausal women. The boundaries for the sequential trials were calculated on the primary outcomes of a difference of cervical dilatation ‡1 mm, with the assumption of a type 1 error of 0.05 and a power of 0.95.Setting Norwegian university teaching hospital.Sample Eighty-six women referred to outpatient operative hysteroscopy.Methods The women were randomised to either 1000 micrograms of self-administered vaginal misoprostol or self-administered vaginal placebo the evening before outpatient operative hysteroscopy.Main outcome measures Preoperative cervical dilatation (primary outcome), number of women who achieve a preoperative cervical dilatation ‡5 mm, acceptability, complications and adverse effects (secondary outcomes).Results In premenopausal women, the mean cervical dilatation was 6.4 mm (SD 2.4) in the misoprostol group and 4.8 mm (SD 2.0) in the placebo group, the mean difference in cervical dilatation being 1.6 mm (95% CI 0.5-2.7). Among the premenopausal women receiving misoprostol, 88% achieved a cervical dilatation of ‡5 mm compared with 65% in the placebo group. Twelve percent of the women who received misoprostol were difficult to dilate compared with 32% who received placebo. Dilatation was also quicker in the misoprostol group. Misoprostol had no effect on cervical ripening in postmenopausal women compared with placebo, and 43% of the women were difficult to dilate. The trials were terminated after analysis of 21 postmenopausal women and 65 premenopausal women after reaching a conclusion on the primary outcome with only 28% of the number of women needed in a fixed sample size trial. Three of 45 women who received misoprostol experienced severe lower abdominal pain, and there was an increased occurrence of light preoperative bleeding in the misoprostol group. Most women did not experience misoprostol-related adverse effects. The majority (83% of premenopausal and 76% of postmenopausal women) found self-administered vaginal misoprostol at home to be acceptable. There were two serious complications in the premenopausal misoprostol group: uterine perforation with subsequent peritonitis and heavy postoperative bleeding requiring blood transfusion, but these were not judged to be misoprostol related. Complications were otherwise comparatively minor and distributed equally between the two dosage groups.Conclusions One thousand micrograms of self-administered vaginal misoprostol 12 hours prior to operative hysteroscopy has a significant cervical ripening effect compared with placebo in premenopausal but not in postmenopausal women. Self-administered vaginal misoprostol of 1000 micrograms at home the evening be...

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“…88 Randomised trials have shown that misoprostol improves the ease with which the cervix can be dilated and reduces complications in premenopausal women, 89 postmenopausal women 89,90 and nulliparous women 91 undergoing operative hysteroscopy.…”

Section: Cervical Primingmentioning

confidence: 99%

FFPRHC Guidance (January 2004) The Copper Intrauterine Device as Long-term Contraception

Penney

Brechin²,

Souza³

et al. 2004

j fam plann reprod health care

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This Guidance provides information for clinicians providing women with copper-bearing intrauterine devices as long-term contraception. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: acquired immune deficiency syndrome (AIDS); actinomyces-like organisms (ALOs); automated external defibrillator (AED); blood pressure (BP); British National Formulary (BNF); confidence interval (CI); copper-bearing intrauterine contraceptive device (IUD); emergency contraception (EC); Faculty Aid to Continuing Professional Development Topic (FACT); levonorgestrel-releasing intrauterine system (IUS); human immunodeficiency virus (HIV); Medicines and Healthcare products Regulatory Agency (MHRA); non-steroidal antiinflammatory drugs (NSAIDs); odds ratio (OR); pelvic inflammatory disease (PID); relative risk (RR); Royal College of Obstetricians and Gynaecologists (RCOG); Scottish Intercollegiate Guidelines Network (SIGN); sexually transmitted infection (STI); termination of pregnancy (TOP); World Health Organization (WHO); WHO Medical Eligibility Criteria (WHOMEC); WHO Selected Practice Recommendations (WHOSPR).

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A randomised placebo-controlled trial of vaginal misoprostol for cervical priming before hysteroscopy in postmenopausal women

Cited by 17 publications

References 3 publications

Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy

Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy

Comparison of self‐administered vaginal misoprostol versus placebo for cervical ripening prior to operative hysteroscopy using a sequential trial design*

FFPRHC Guidance (January 2004) The Copper Intrauterine Device as Long-term Contraception

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