Vaginal Dinoprostone in Reducing Pain Perception During Diagnostic Office Hysteroscopy in Postmenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Trial

Samy, Ahmed; Abbas, Ahmed M.; Rashwan, A.; Talaat, Bassem; Eissa, Ahmed Ibrahim; Hammad, Bahaa Eldin M.; Ibrahim, Ahmed M. S.; Elzahaby, Iman; Zaki, Sherif Mohamed; Sharkawy, Mohamed El

doi:10.1016/j.jmig.2019.07.026

Cited by 16 publications

(25 citation statements)

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“…After the initial title and abstract screening, the full‐texts of 100 potentially eligible citations were retrieved for evaluation. Finally, 39 RCT (Women n = 3964) were included in the present systematic review and NMA. Figure shows the PRISMA flowchart.…”

Section: Resultsmentioning

confidence: 99%

Evaluation and ranking of different interventions for pain relief during outpatient hysteroscopy: A systematic review and network meta‐analysis

Ghamry

Samy

Abdelhakim

et al. 2020

J of Obstet and Gynaecol

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Section: Resultsmentioning

confidence: 99%

Evaluation and ranking of different interventions for pain relief during outpatient hysteroscopy: A systematic review and network meta‐analysis

Ghamry

Samy

Abdelhakim

et al. 2020

J of Obstet and Gynaecol

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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%

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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“…A meta-analysis demonstrated that while dinoprostone is efficaciously equivalent to misoprostol in labor induction, it is associated with better toxicity profile, particularly in terms of lower frequencies of tachysystole and hypertonic uterine dysfunction (16). Also, use of dinoprostone has been extended to non-obstetric indications such as hysteroscopy in nulliparous (17) and postmenopausal (18) women and correlated with better pain control and ease of procedure when compared to placebo or misoprostol. This study further supports the clinical utility of dinoprostone in an additional non-obstetric indication—that is, during IUD insertion to control procedure-related pain and facilitate its ease of conduction.…”

Section: Discussionmentioning

confidence: 99%

“…It is frequently employed in obstetrics for labor induction, which is mediated through cervical ripening and prompting of uterine contractions with an equivalent labor-inducing efficacy to misoprostol but substantially less adverse events (16). Additionally, dinoprostone has been exploited successfully prior to diagnostic hysteroscopy to ease the procedure and reduce associated pain without considerable toxicity when compared to placebo or misoprostol (17, 18). Only a very limited number of trials examined the safety and efficacy of vaginal dinoprostone versus placebo in facilitating IUD insertion and decreasing its related pain (12, 18-21).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, dinoprostone has been exploited successfully prior to diagnostic hysteroscopy to ease the procedure and reduce associated pain without considerable toxicity when compared to placebo or misoprostol (17, 18). Only a very limited number of trials examined the safety and efficacy of vaginal dinoprostone versus placebo in facilitating IUD insertion and decreasing its related pain (12, 18-21). To date, no meta-analysis has been conducted to amass the data and inform concrete conclusions.…”

Section: Introductionmentioning

confidence: 99%

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Vaginal dinoprostone versus placebo for pain relief during intrauterine device insertion: a systematic review and meta-analysis of randomized controlled trials

Abu‐Zaid

Alshahrani

Albezrah

et al. 2020

Preprint

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Objective: To investigate the safety and efficacy of vaginal dinoprostone versus placebo in pain relief during intrauterine device (IUD) insertion. Design: Systematic review and meta-analysis of randomized placebo-controlled trials. Setting: Not applicable. Patient(s): Women undergoing IUD insertion and receiving vaginal dinoprostone or placebo. Intervention(s): PubMed, Scopus, Web of Science, and Cochrane Library were screened from inception to 01-October-2020, using the following search strategy: (dinoprostone OR cervidil OR prepidil) AND (intrauterine device OR iud). Main outcome measure(s): IUD insertion related pain, patient satisfaction, provider ease of IUD insertion, and side effects. Result(s): Five studies met the study inclusion criteria, comprising 862 patients; equally 431 patients received vaginal dinoprostone and placebo. All studies had an overall low risk of bias. When compared to placebo, dinoprostone significantly correlated with decreased pain at tenaculum placement (SMD=-0.79, 95% CI [-1.43, -0.16], p=0.01), decreased pain at uterine sounding (SMD=-0.88, 95% CI [-1.54, -0.22], p=0.009), decreased pain at IUD insertion (SMD=-1.18, 95% CI [-1.74, -0.61], p<0.001), decreased need for additional analgesia (RR=0.34, 95% CI [0.22, 0.53], p<0.001), increased patient satisfaction (SMD=1.41, 95% CI [0.62, 2.20], p<0.001), and increased provider ease of IUD insertion (SMD=-1.17, 95% CI [-1.62, -0.73], p<0.001). Fever was statistically significantly higher in dinoprostone versus placebo group (RR=3.73, 95% CI [1.47, 9.44], p=0.006). All other side effects-including nausea, vomiting, shivering, diarrhea, abdominal cramps, vasovagal attack, uterine perforation, and postprocedural bleeding-did not substantially differ between both groups. Conclusions: This first ever meta-analysis advocates that dinoprostone is safe, effective, and yields favorable analgesic outcomes during IUD insertion.

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Vaginal Dinoprostone in Reducing Pain Perception During Diagnostic Office Hysteroscopy in Postmenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Trial

Cited by 16 publications

References 30 publications

Evaluation and ranking of different interventions for pain relief during outpatient hysteroscopy: A systematic review and network meta‐analysis

Evaluation and ranking of different interventions for pain relief during outpatient hysteroscopy: A systematic review and network meta‐analysis

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

Vaginal dinoprostone versus placebo for pain relief during intrauterine device insertion: a systematic review and meta-analysis of randomized controlled trials

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