Determining the Optimal Time Interval between Vaginal Dinoprostone Administration and Diagnostic Office Hysteroscopy in Nulliparous Women: A Randomized, Double-blind Trial

Rund, Nansy Mohamed Ali; Shenoufy, Hossam El; Islam, Bassem Aly; Husseiny, Tarek El; Nassar, Salma Ashraf; Mohsen, Reham A.; Alaa, Doaa; Allah, Sherine H. Gad; Bakry, Ahmed; Refaat, Rania; Gehad, Mahmoud A.; Kotb, Magd A.; Osman, Omar; Ashour, Ahmed; Ali, Ahmed Said; Taher, Ayman; Kholaif, Khaled; Hashem, Ahmed T.; Elsallamy, Ayman Aly Hamed; Nour, Dalia Adel; Dahab, Sherif; Talaat, Bassem; Almohammady, Maged

doi:10.1016/j.jmig.2021.06.021

Cited by 3 publications

(2 citation statements)

References 47 publications

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“…Moreover, women reported a greater satisfaction (p < 0.001) and the hysteroscope insertion through the cervical canal was easier (p = 0.003) and faster (p < 0.001) in group with a long-interval dinoprostone rather than the short-interval group. The prevalence of side effects was found similar in both groups [42].…”

Section: Pharmacological Strategiessupporting

confidence: 50%

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Pain Management during Office Hysteroscopy: An Evidence-Based Approach

Buzzaccarini

Pacheco²,

Vitagliano

et al. 2022

Medicina

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Background and Objectives: Hysteroscopy is a reliable technique which is highly useful for the evaluation and management of intrauterine pathology. Recently, the widespread nature of in-office procedures without the need for anesthesia has been requesting validation of practical approach in order to reduce procedure-related pain. In this regard, we performed a comprehensive review of literature regarding pain management in office hysteroscopic procedures. Materials and Methods: MEDLINE, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), Global Health, Health Technology Assessment Database and Web of Science, other research registers (for example Clinical Trials database) were searched. We searched for all original articles regarding pain relief strategy during office hysteroscopy, without date restriction. Results have been collected and recommendations have been summarized according to the Appraisal of Guidelines for Research and Evaluation (AGREE) tool. Moreover, the strength of each recommendation was scored following the Grading of Recommendations Assessment (GRADE) system, in order to present the best available evidence. Results: Both pharmacological and non-pharmacological strategies for pain management are feasible and can be applied in office setting for hysteroscopic procedures. The selection of strategy should be modulated according to the characteristics of the patient and difficulty of the procedure. Conclusions: Accumulating evidence support the use of pharmacological and other pharmacological-free strategies for reducing pain during office hysteroscopy. Nevertheless, future research priorities should aim to identify the recommended approach (or combined approaches) according to the characteristics of the patient and difficulty of the procedure.

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Section: Pharmacological Strategiessupporting

confidence: 50%

“…[42] Dinoprostone 3 mg of dinoprostone vaginally located 12 h before the office hysteroscopic procedure Hameed and Farhan[43] Haghighi et al[46] Issat et al[44] Gokmen Karasu et al[45] …”

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confidence: 99%

Pain Management during Office Hysteroscopy: An Evidence-Based Approach

Buzzaccarini

Pacheco²,

Vitagliano

et al. 2022

Medicina

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Outpatient Hysteroscopy

De Silva,

Smith,

Cooper

et al. 2024

BJOG

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Key recommendations All gynaecology departments should provide a dedicated outpatient hysteroscopy service to aid care of women and people with abnormal uterine bleeding, reproductive problems, and insertion/retrieval of intrauterine devices. [Grade A] Written information should be provided to the woman prior to their appointment. This should include details about the procedure, the benefits and risks, advice regarding pre‐operative analgesia, as well as alternative options for care and contact details for the hysteroscopy unit. [Good Practice Point] Women should be made aware of other settings and modes of anaesthesia for hysteroscopy (e.g. under general or regional anaesthesia or intravenous sedation). [GPP] The woman should be advised that if they find the procedure too painful or distressing at any point, they must alert the clinical team who will stop the procedure immediately. The clinical team should alert the hysteroscopist if the woman appears to be in too much pain or is experiencing a vasovagal episode and therefore unable to voice the concerns so that the procedure can be stopped. [GPP] Women should be advised to take standard doses of oral non‐steroidal anti‐inflammatory agents (NSAIDs) one hour before their scheduled appointment. Vaginoscopy should be the standard technique for outpatient hysteroscopy unless the use of a vaginal speculum is required (e.g. for administering local cervical anaesthesia or dilating the cervix). [Grade A] When performing operative hysteroscopy, the smallest diameter hysteroscope should be used, with consideration given to the use of hysteroscopes with expandable outer working channels because they are associated with less pain. [Grade B] Mechanical hysteroscopic tissue removal systems should be preferred over miniature bipolar electrodes to remove endometrial polyps. [Grade A] Local anaesthesia should not be routinely administered prior to outpatient hysteroscopy where a vaginoscopic approach is used. It should be considered where use of a vaginal speculum is planned e.g. for cervical dilatation if anticipated, due to either cervical stenosis and/or the utilisation of larger‐diameter hysteroscopes (≥5mm outer diameter). [Grade A] Saline should be instilled at the lowest possible pressure to achieve a satisfactory view. [Grade A] Conscious sedation should not be routinely used in outpatient hysteroscopic procedures. [Grade B]

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The effect of consuming evening primrose oil on cervical preparation before hysteroscopy: An RCT

Ghanaei¹,

Asgharnia²,

Farokhfar³

et al. 2022

IJRM

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Background: Herbal medicine could be effective at treating various illnesses. Hysteroscopy can be an effective method for assessing the uterus in terms of anatomical, physiological and pathological anomalies. Objective: This study aims to evaluate the effect of evening primrose oil (EPO) on cervical preparation in women candidates for hysteroscopy. Materials and Methods: This study was a double-blind, randomized controlled clinical trial including 160 women candidates for diagnostic hysteroscopy who were referred to Alzahra hospital from August 2019-March 2020. They were divided into 2 groups. Group A received 100 mg EPO as a soft gel capsule 6 hr before the hysterectomy in the posterior vaginal fornix. Group B received a placebo. After receiving the treatment, primary and secondary outcomes were evaluated in the groups. Results: The average Hegar size in the EPO group was larger than in the control group (p < 0.001 for both). Also, the need for mechanical dilation, the time taken until the first resistance and the time of dilatation completion in the EPO group were significantly less than in the placebo group (p < 0.008 for all). There was also greater ease of dilatation in the EPO group. Side effects such as uterine rupture, false passage, cervical rupture, allergic reaction, abdominal pain, nausea, diarrhea, headache and increase of bowel movements were not reported in any cases. Conclusion: Based on the findings of the present study, EPO is effective for cervical preparation in women undergoing hysteroscopy. Key words: Hysteroscopy, Dilatation, EPOGAM, Gamma-linolenic acid.

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Determining the Optimal Time Interval between Vaginal Dinoprostone Administration and Diagnostic Office Hysteroscopy in Nulliparous Women: A Randomized, Double-blind Trial

Cited by 3 publications

References 47 publications

Pain Management during Office Hysteroscopy: An Evidence-Based Approach

Pain Management during Office Hysteroscopy: An Evidence-Based Approach

Outpatient Hysteroscopy

The effect of consuming evening primrose oil on cervical preparation before hysteroscopy: An RCT

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