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Rahimi M, Haghighi L, Baradaran HR, Azami M, Larijani SS, Kazemzadeh P, Moradi Y. Comparison of the effect of oral and vaginal misoprostol on labor induction: updating a systematic review and meta-analysis of interventional studies. Eur J Med Res 2023; 28:51. [PMID: 36707858 PMCID: PMC9881312 DOI: 10.1186/s40001-023-01007-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES This study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis. METHODS Electronic databases including PubMed [Medline], Scopus, Web of science, Embase, Ovid, Cochrane library, and ClinicalTrials.gov were searched using the relevant keywords. All RCTs comparing the effect of oral vs vaginal misoprostol on labor induction were considered. The Cochrane Risk of Bias checklist was used for assessing quality of included RCTs. All statistical analyses were completed using STATA (Version 16) and Revman (Version 5). RESULTS Thirty-three RCTs with 5162 patients (1560 in oral and 2602 in vaginal groups) were included in this meta-analysis. Labor induction length did differ significantly between the two routes of misoprostol administration [Standardized Mean Difference: 0.40 h, 95% confidence interval (CI) 0.34, 0.46; I2: 66.35%; P = 0.04]. In addition, the risk of neonatal death, tachysystole, uterine hyperstimulation, preeclampsia, non-FHR and abortion was lower in the oral misoprostol group and the risk of hypertonus, PROM, oxytocin need and cesarean fever was higher in this group than the vaginal misoprostol group. CONCLUSIONS Based on results of this meta-analysis, it can be inferred that currently, clinical specialists can decide to use this drug orally or vaginally on a case-by-case basis, depending on the condition of the pregnant mother and the baby.
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Affiliation(s)
- Maryam Rahimi
- grid.411746.10000 0004 4911 7066Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ladan Haghighi
- grid.411746.10000 0004 4911 7066Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- grid.7107.10000 0004 1936 7291 Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK ,grid.411746.10000 0004 4911 7066Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mobin Azami
- grid.484406.a0000 0004 0417 6812Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Samaneh Saghafian Larijani
- grid.411746.10000 0004 4911 7066Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Paniz Kazemzadeh
- grid.411746.10000 0004 4911 7066Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Moradi
- grid.484406.a0000 0004 0417 6812Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran ,grid.484406.a0000 0004 0417 6812Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology. Obstet Gynecol 2022; 140:499-513. [PMID: 35926213 DOI: 10.1097/aog.0000000000004898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/19/2022] [Indexed: 01/05/2023]
Abstract
Hysteroscopy provides a minimally invasive strategy to evaluate intrauterine pathology and manage conditions such as abnormal uterine bleeding, infertility, intrauterine adhesions, müllerian anomalies, and intrauterine foreign bodies. Increasing access to hysteroscopy procedures in the office has the potential to improve patient care by minimizing financial and logistical barriers, aiding in streamlined diagnosis and treatment planning, and potentially averting unnecessary operative procedures and anesthesia. Office hysteroscopy refers to procedures performed in outpatient settings where pain management involves no medications, oral nonsedating medications, local anesthetic agents, or oral or inhaled conscious sedation. We present best practices for the implementation of hysteroscopy in an office setting. These include appropriate patient selection, optimal procedural timing, cervical preparation for patients at highest risk of cervical stenosis or pain with dilation, individualized pain-management strategies, use of distension media, and video monitoring to engage patients in the procedure. We describe miniaturized equipment for use in the office setting and "no-touch" vaginoscopic approaches to limit patient discomfort. With appropriate training and experience, office hysteroscopy presents a simple and cost-effective modality for optimizing gynecologic care for our patients.
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Inácio QAS, Troncon JK, Valério FP, Herren H, Nogueira AA, Neto OBP, Silva JCRE. Misoprostol Administration Before Hysteroscopy Procedures - A Retrospective Analysis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1102-1109. [PMID: 36037813 PMCID: PMC9800141 DOI: 10.1055/s-0042-1755462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the use of misoprostol prior to hysteroscopy procedures regarding technical ease, the presence of side effects, and the occurrence of complications. METHODS This is a retrospective, observational, analytical, case-control study, with the review of medical records of 266 patients followed-up at the Gynecological Videoendoscopy Sector of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of the Universidade de São Paulo (HCFMRP - USP, in the Portuguese acronym) from 2014 to 2019, comparing 133 patients who used the drug before the procedure with 133 patients who did not. RESULTS The occurrence of postmenopausal uterine bleeding was the main indication for hysteroscopy and revealed a statistical difference between groups (p < 0.001), being present in 93.23% of the patients in the study group and in 69.7% of the patients in the control group.: Only 2 patients (1.5%) in the study group reported adverse effects. Although no statistical differences were observed regarding the occurrence of complications during the procedure (p = 0.0662), a higher total number of complications was noted in the group that used misoprostol (n = 7; 5.26%) compared with the group that did not use the drug (n = 1; 0.75%), a fact that is clinically relevant. When evaluating the ease of the technique (measured by the complete performance of all steps of the hysteroscopy procedure), it was verified that although there was no difference between groups (p = 0.0586), the control group had more than twice as many incompletely performed procedures (n = 17) when compared with the group that used misoprostol previously (n = 8), which is also clinically relevant. CONCLUSION The use of misoprostol prior to hysteroscopy in our service indicated that the drug can facilitate the performance of the procedure, but not without side effects and presenting higher complication rates.
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Affiliation(s)
- Quênya Antunes Silveira Inácio
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Júlia Kefalás Troncon
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Fernando Passador Valério
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Helmer Herren
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Antônio Alberto Nogueira
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Omero Benedicto Poli Neto
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Júlio César Rosa e Silva
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil,Address for correspondence Júlio César Rosa e Silva, MD, PhD Av. Bandeirantes3900, 14049-900, Ribeirão Preto, SPBrazil
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Chidambaram V, Pallavee P, Samal R, Ghose S. A randomised comparative study of sublingual and vaginal misoprostol for cervical priming before minor gynaecological procedures. J OBSTET GYNAECOL 2022; 42:2297-2301. [PMID: 35468032 DOI: 10.1080/01443615.2022.2042224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to compare the effect of misoprostol using vaginal or sublingual routes on the non-pregnant uterine cervix prior to minor gynaecological procedures. One hundred and forty women were randomised 1:1 into two groups: A and B. Group A received misoprostol 400 mcg vaginally and pyridoxine 40 mg sublingually and Group B received misoprostol 400 mcg sublingually and pyridoxine 40 mg vaginally 4 h prior to procedure. The outcomes studied were maximum size of Hegar's dilator that could be inserted into the cervix without any resistance, ease of dilatation, need and time required for further dilatation, side effects and complications. Baseline cervical dilatation was significantly more in Group A than Group B. Need for further dilatation and time required for further dilatation were also significantly less in Group A than Group B. Thus, we conclude that vaginal misoprostol is more effective than sublingual misoprostol in cervical priming before minor gynaecological procedures. Clinical Trial Registration Number: www.ctri.nic.in; CTRI/2018/07/015080 IMPACT STATEMENTWhat is already known on this subject? Cervical priming has been shown to result in shorter operative time, easier mechanical dilatation, reduced incidence of complications and blood loss when used prior to surgical abortion and has been recommended as a standard practice in various national and international guidelines for safe abortion practices. Misoprostol has many advantages over other ripening agents like osmotic dilators, other prostaglandins and mifepristone. Misoprostol can be given through oral, sublingual, vaginal, buccal and rectal routes. Use of misoprostol has been found to improve cervical dilatation, reduce need of further dilatation and ease of dilatation without many complications when compared to placebo for cervical priming of non-pregnant cervix. Studies comparing vaginal and sublingual routes have shown no significant difference for cervical ripening in pregnant women.What the results of this study add? We found that vaginal misoprostol for cervical priming was more effective than sublingual misoprostol in reaching a higher baseline cervical dilatation, with reduced need and time required for further dilatation before minor gynaecological procedures, although the ease of dilatation was similar in both groups. This effect of vaginal misoprostol was more marked in premenopausal women.What the implications are of these findings for clinical practice and/or further research? The results of our study are at variance with other studies done on use of misoprostol via the vaginal or sublingual routes, and hence it is imperative that large multi-center studies be performed to bring about consensus on the topic.
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Affiliation(s)
- Vidhya Chidambaram
- Department of Obstetrics & Gynaecology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (Deemed-to-be-University), Pillaiyarkuppam, India
| | - P Pallavee
- Department of Obstetrics & Gynaecology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (Deemed-to-be-University), Pillaiyarkuppam, India
| | - Rupal Samal
- Department of Obstetrics & Gynaecology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (Deemed-to-be-University), Pillaiyarkuppam, India
| | - Seetesh Ghose
- Department of Obstetrics & Gynaecology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (Deemed-to-be-University), Pillaiyarkuppam, India
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Intravaginal isonicotinic acid hydrazide (INH) versus misoprostol for cervical ripening prior to hysteroscopy. Obstet Gynecol Sci 2020; 63:514-520. [PMID: 32550739 PMCID: PMC7393750 DOI: 10.5468/ogs.19170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/16/2020] [Indexed: 11/08/2022] Open
Abstract
Objective The aim of the present study was to compare the efficacy of vaginal isoniazid (isonicotinic acid hydrazide [INH]) and vaginal misoprostol in cervical ripening before hysteroscopic surgery. Methods This randomized controlled trial included patients scheduled for hysteroscopic surgery during April 2016 and June 2017. The inclusion criteria were as follows: postmenopausal women or those at premenopausal age who had not had a vaginal delivery and candidate for diagnostic or operative hysteroscopy with closed cervix before intervention. The INH group (intervention group) received 900 mg of vaginal isoniazid (three 300-mg pills) 6–8 hours before hysteroscopic surgery. The misoprostol group (control group) received 400 micrograms of vaginal misoprostol 6–8 hours before hysteroscopic surgery. Finally, the efficacy of the 2 agents was comparatively analyzed. Results Baseline characteristics were comparable between the groups. In 67 cases in the INH group (95%) and 45 in the misoprostol group (50%), hysteroscopic entry was successful without additional mechanical dilation, and this difference was statistically significant (P=0.001). The odds ratio (OR) obtained in this study was 0.57 for both INH and misoprostol groups (OR, 0.57; 95% confidence interval, 0.43–0.75). Further, 19 cases in the INH group vs. 45 cases in the misoprostol group did not respond to the intervention, indicating statistically significance (P=0.001). Conclusion Vaginal INH is more effective than misoprostol in cervical ripening before hysteroscopic surgery and can be a good alternative to misoprostol. Trial Registration Iranian Registry Clinical Trial (IRCT) Identifier: IRCT2015112821506N4
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Tassi A, Parisi N, Londero AP. Misoprostol administration prior to intrauterine contraceptive device insertion: a systematic review and meta-analysis of randomised controlled trials. EUR J CONTRACEP REPR 2020; 25:76-86. [PMID: 31914331 DOI: 10.1080/13625187.2019.1706079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives: Misoprostol has been used before intrauterine contraceptive device (IUCD) insertion to prime the cervical os. As the literature about this topic is controversial, we aimed to evaluate IUCD insertion failure, women's pain perception, use of cervical dilators and prevalence of side effects following the administration of misoprostol.Methods: Trials published in MEDLINE, Scopus, the Cochrane Library and ClinicalTrials.gov were searched (last search on 23 October 2019). The primary outcome was IUCD insertion failure; secondary outcomes were women's pain perception, use of cervical dilators to facilitate insertion, and prevalence of side effects.Results: Fourteen studies were eligible for inclusion. Misoprostol premedication reduced IUCD insertion failure rates and the use of cervical dilators but significantly increased the prevalence of side effects. The risk of IUCD insertion failure with misoprostol premedication was reduced among women who had undergone previous caesarean section and among women who had experienced previous IUCD insertion failure. Nulliparas did not benefit from misoprostol premedication. Buccal misoprostol administration did not seem to be effective in reducing IUCD insertion failure. Visual analogue scale pain scores were increased with both sublingual and buccal misoprostol administration if IUCD insertion was performed ≤2.5 h after misoprostol premedication.Conclusion: Our data demonstrate reduced IUCD insertion failure among women with previous caesarean section and those with previous IUCD insertion failure, suggesting that misoprostol may be a reasonable choice in these groups of women. Although misoprostol premedication reduced insertion failures, it significantly increased side effects and had a heterogeneous pattern of efficacy; thus, its routine use is not supported by the evidence.
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Affiliation(s)
- Alice Tassi
- Clinic of Obstetrics and Gynaecology, University Hospital of Udine, Udine, Italy
| | - Nadia Parisi
- Clinic of Obstetrics and Gynaecology, University Hospital of Udine, Udine, Italy
| | - Ambrogio P Londero
- Clinic of Obstetrics and Gynaecology, University Hospital of Udine, Udine, Italy.,Ennergi Research, Lestizza, Italy
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Abdelhakim AM, Gadallah AH, Abbas AM. Efficacy and safety of oral vs vaginal misoprostol for cervical priming before hysteroscopy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019; 243:111-119. [DOI: 10.1016/j.ejogrb.2019.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
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Abstract
Hysteroscopy is performed to view and treat pathology within the uterine cavity and endocervix. Diagnostic hysteroscopy allows visualization of the endocervical canal, endometrial cavity, and fallopian tube ostia. Operative hysteroscopy incorporates the use of mechanical, electrosurgical, or laser instruments to treat intracavitary pathology and perform hysteroscopic sterilization procedures. Selection of a distending medium requires consideration of the advantages, disadvantages, and risks associated with various media as well as their compatibility with electrosurgical or laser energy. A preoperative consultation allows the patient and physician to discuss the hysteroscopic procedure, weigh its inherent risks and benefits, review the patient's medical history for any comorbid conditions, and exclude pregnancy. Known pregnancy, genital tract infections, and active herpetic infection are contraindications to hysteroscopy. The most common perioperative complications associated with operative hysteroscopy are hemorrhage, uterine perforation, and cervical laceration. The procedure is minimally invasive and can be used with a high degree of safety.
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Zhuo Z, Yu H, Gao L, Jiang X. Effectiveness of misoprostol administration for cervical ripening in women before operative hysteroscopy: a randomized, double-blinded controlled trial. MINIM INVASIV THER 2019; 28:344-350. [PMID: 30907209 DOI: 10.1080/13645706.2018.1559195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Zhihong Zhuo
- Ningbo No. 2 Hospital, Ningbo, People’s Republic of China
| | - Huimin Yu
- Ningbo No. 2 Hospital, Ningbo, People’s Republic of China
| | - Li Gao
- Ningbo No. 2 Hospital, Ningbo, People’s Republic of China
| | - Xingzhi Jiang
- Ningbo No. 2 Hospital, Ningbo, People’s Republic of China
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Falcone F, Raimondo G, Stark M, Dessole S, Torella M, Raimondo I. Balloon Catheter for Cervical Priming before Operative Hysteroscopy in Young Women: A Pilot Study. J INVEST SURG 2018; 33:301-306. [PMID: 30380354 DOI: 10.1080/08941939.2018.1503379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: To investigate regarding the safety and effectiveness of a balloon catheter (Aqueduct-100 device) to dilate the uterine cervix before operative hysteroscopies. Secondary objectives were to evaluate the duration of the dilatation procedure and to investigate on physicians' satisfaction with the device. Methods: Fifty women younger than 40 years, wishing pregnancies and diagnosed with apparently benign intrauterine lesions and/or uterine anomalies, were enrolled into this study and submitted to cervical priming with Aqueduct-100 device before operative hysteroscopy. Results: Initial cervical dilatation was ≤4 mm in all but one patient. Adequate (10 mm) cervical dilatation was achieved in only one patient, the remaining forty-nine needed additional cervical dilatation. All women, however, presented with a ≥6 mm cervical width after balloon catheter removal. The mean time to final cervical dilatation was 8.5 minutes. No perioperative complications occurred. Physicians reported, in the majority of cases, satisfaction for the dilatation achieved (66%), the ease of balloon catheter insertion/use (82%), and for the ease of additional dilatation (96%). Conclusions: Aqueduct-100 device before operative hysteroscopy is safe and useful to increase the baseline cervical width and facilitate additional dilatation, with good effects on physician satisfaction and acceptable dilatation times.
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Affiliation(s)
- Francesca Falcone
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Michael Stark
- The New European Surgical Academy, Berlin, Germany, Charitè University Hospital, Berlin, Germany, ELSAN Group Hospitals, Paris, France
| | - Salvatore Dessole
- Gynecologic and Obstetric Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ivano Raimondo
- Gynecologic and Obstetric Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
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Optimal Dose of Vaginal Misoprostol for Cervical Ripening before Hysteroscopy: A Randomized Double-Blind Study. J Minim Invasive Gynecol 2018; 25:1031-1034. [DOI: 10.1016/j.jmig.2018.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/20/2022]
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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. Arch Gynecol Obstet 2018; 298:133-137. [DOI: 10.1007/s00404-018-4764-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
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Khalaf M, Amin AF, Sayed Z, El-Nashar IM, Abbas AM. A randomized double-blind controlled trial of two different doses of self-administered vaginal misoprostol for successful copper intrauterine device insertion. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abdellah MS, Abbas AM, Hegazy AM, El-Nashar IM. Vaginal misoprostol prior to intrauterine device insertion in women delivered only by elective cesarean section: a randomized double-blind clinical trial. Contraception 2017; 95:538-543. [DOI: 10.1016/j.contraception.2017.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
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Ganer Herman H, Kerner R, Gluck O, Feit H, Keidar R, Bar J, Sagiv R. Different Routes of Misoprostol for Same-Day Cervical Priming Prior to Operative Hysteroscopy: A Randomized Blinded Trial. J Minim Invasive Gynecol 2017; 24:455-460. [PMID: 28069480 DOI: 10.1016/j.jmig.2016.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/14/2016] [Accepted: 12/31/2016] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To compare the effectiveness of and patient satisfaction with different routes of misoprostol administration for short-term cervical priming before operative hysteroscopy. DESIGN Randomized blinded trial (Canadian Task Force classification I). SETTING University hospital. PATIENTS One hundred and twenty patients undergoing operative hysteroscopy. INTERVENTIONS Patients were randomly assigned to receive 400 μg of misoprostol administered orally (n = 40), vaginally (n = 40), or sublingually (n = 40) for cervical priming at 1.5 to 4 hours before undergoing operative hysteroscopy. MEASUREMENTS AND MAIN RESULTS The primary outcome was preoperative cervical dilatation. Secondary outcomes included cervical consistency, ease of dilation and time of dilation, patient discomfort, and side effects. No differences were noted among the 3 groups in terms of patient age, parity, previous vaginal delivery, menopausal status, and time interval from preparation to procedure. Patients in the 3 groups reported similar discomfort and side effects. Initial mean cervical dilatation was 6.1 ± 2.0 mm in the oral group, 6.4 ± 2.1 in the vaginal group, and 6.4 ± 1.8 mm in the sublingual group (p = .75). Cervical consistency and ease of dilation were similar among the groups. The mean time of dilation was 37.2 ± 30.6 seconds in the oral group, 31.7 ± 29.0 seconds in the vaginal group, and 31.5 ± 21.7 seconds in the sublingual group (p = .59). Additional subanalyses according to menopausal status and parity did not demonstrate any differences among the groups. CONCLUSION Same-day cervical priming for operative hysteroscopy is achieved equally with all routes of misoprostol administration, with similar patient satisfaction and side effects.
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Affiliation(s)
- Hadas Ganer Herman
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ram Kerner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Feit
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Keidar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hua Y, Zhang W, Hu X, Yang A, Zhu X. The use of misoprostol for cervical priming prior to hysteroscopy: a systematic review and analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:2789-2801. [PMID: 27660411 PMCID: PMC5019271 DOI: 10.2147/dddt.s111625] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The effects of misoprostol use on cervical priming prior to hysteroscopy have been controversial. Therefore, a systematic literature review and meta-analysis of studies were conducted to assess the effect of misoprostol on cervical priming prior to hysteroscopy. All studies published before July 2014 with data related to the use of misoprostol for cervical priming compared with placebo or no medication prior to hysteroscopy, were identified. Twenty-five randomized controlled trials involving 2,203 females were systematically analyzed. The results showed that, compared with placebo or no medication, the use of misoprostol prior to hysteroscopy led to a significant relief of the need for cervical dilatation, resulted in a significantly greater cervical width, had fewer hysteroscopy complications, and mild and insignificant side effects. Subgroup analyses revealed that the regimen of 200 or 400 μg vaginal misoprostol may be a simple and effective method for cervical priming, especially prior to operative hysteroscopy.
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Affiliation(s)
- Ying Hua
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Wenwen Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiaoli Hu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Ansu Yang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Excision of Endocervical Polyps Under Local Anesthesia in Rural Hospitals: A Case Series. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Role of vaginal estradiol pretreatment combined with vaginal misoprostol for cervical ripening before operative hysteroscopy in postmenopausal women. Obstet Gynecol Sci 2016; 59:220-6. [PMID: 27200313 PMCID: PMC4871939 DOI: 10.5468/ogs.2016.59.3.220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/10/2015] [Accepted: 11/30/2015] [Indexed: 12/05/2022] Open
Abstract
Objective To assess the efficacy and safety of vaginal misoprostol after a pretreatment with vaginal estradiol to facilitate the hysteroscopic surgery in postmenopausal women. Methods In this observational comparative study, 35 control women (group A) did not receive any pharmacological treatment,26 women (group B) received 25 µg of vaginal estradiol daily for 14 days and 400 µg of vaginal misoprostol 12 hours before hysteroscopic surgery, 32 women (group C) received 400 µg of vaginal misoprostol 12 hours before surgery. Results Demographic data were well balanced and all variables were not significantly different among the three groups. The study showed a significant difference in the preoperative cervical dilatation among the group B (7.09±1.87 mm), the group A (5.82±1.85 mm; B vs. A, P=0.040) and the group C (5.46±2.07 mm; B vs. C, P=0.007). The dilatation was very easy in 73% of women in group B. The pain scoring post surgery was lower in the group B (B vs. A, P=0.001; B vs. C, P=0.077). In a small subgroup of women with suspected cervical stenosis, there were no statistically significant differences among the three groups considered. No complications during and post hysteroscopy were observed. Conclusion In postmenopausal women the pretreatment with oestrogen appears to have a crucial role in allowing the effect of misoprostol on cervical ripening. The combination of vaginal estradiol and vaginal misoprostol presents minor side effects and has proved to be effective in obtaining satisfying cervical dilatation thus significantly reducing discomfort for the patient.
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Karakus S, Akkar OB, Yildiz C, Yenicesu GI, Cetin M, Cetin A. Comparison of Effectiveness of Laminaria versus Vaginal Misoprostol for Cervical Preparation Before Operative Hysteroscopy in Women of Reproductive Age: A Prospective Randomized Trial. J Minim Invasive Gynecol 2016; 23:46-52. [PMID: 26272687 DOI: 10.1016/j.jmig.2015.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To compare the effectiveness and safety of intracervical laminaria dilator versus intravaginal misoprostol administered before surgery to facilitate cervical dilation before operative hysteroscopy. DESIGN A prospective randomized study (Canadian Task Force classification 1). SETTING A university hospital. PATIENTS A total of 150 women were assigned at random to the following groups: laminaria dilation (n = 50), misoprostol dilation (n = 50), and mechanical dilation (n = 50). INTERVENTIONS Hysteroscopic surgery of intrauterine lesions. MEASUREMENTS AND MAIN RESULTS In this study, 150 women were assigned at random to receive cervical priming with an intracervical laminaria dilator, 200 μg of intravaginal misoprostol, or a mechanical dilator before operative hysteroscopy. Cervical response, surgical outcome, and complications of operative hysteroscopy were assessed. Visual analog scale (VAS) pain scores were recorded in the misoprostol and laminaria dilation groups. Demographic variables of the study groups were comparable (p = .278-.988). The duration of cervical pretreatment was similar with the intracervical laminaria dilator and intravaginal misoprostol (p = .803); however, intravaginal misoprostol was associated with more adverse effects (p = .031). Compared with the misoprostol dilation group, in which all patients required additional cervical dilation, notably fewer patients in the laminaria dilation group required additional cervical dilation after cervical preparation (p = .001). VAS pain scores were significantly higher in the laminaria dilation group, however (p = .001). CONCLUSION Cervical priming with an intracervical laminaria dilator before operative hysteroscopy reduces the need for cervical dilation and better facilitates hysteroscopic surgery compared with intravaginal misoprostol. Oral analgesic use may be required before the use of this device.
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Affiliation(s)
- Savas Karakus
- Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey.
| | - Ozlem Bozoklu Akkar
- Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Caglar Yildiz
- Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Gonca Imir Yenicesu
- Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Meral Cetin
- Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Ali Cetin
- Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey
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Saha M, Chakraborty A, Chattopadhyay S, Saha S, Paul J, Das A. Effect of misoprostol for cervical priming before gynecological procedures on nonpregnant premenopausal women. J Nat Sci Biol Med 2015; 6:S123-7. [PMID: 26604599 PMCID: PMC4630743 DOI: 10.4103/0976-9668.166116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Misoprostol is very effective in cervical ripening and is used for termination of pregnancy. A similar effect on the nonpregnant uterus will facilitate gynecological operations, and hence we assessed the effect of misoprostol on the nonpregnant uterus of premenopausal women. MATERIALS AND METHODS In a prospective double-blinded randomized controlled trial, 280 women were randomly allocated into two groups (12 women did not complete the intervention). Study (A) and control (B) group received 400 μg of misoprostol or 400 mg of metronidazole tablets (as a placebo) respectively in the posterior vaginal wall 6 h prior to gynecological procedures. RESULTS The mean cervical dilatation was significantly higher (P < 0.0001) in misoprostol compared to placebo group (4.6 ± 0.96 mm vs. 3.6 ± 0.82 mm), benefit were also observed on secondary outcome measures which were need for further dilatation, time taken for further dilatation, ease of dilatation, subjective assessment of pain by visual analog scale. Only 3.61% patients complained of intolerable pain during dilatation in the study group while in control group 48.74% complained of intolerable pain and required anesthesia. Most common side effects of misoprostol were abdominal pain and mild vaginal bleeding. CONCLUSION Misoprostol was effective in cervical ripening of nonpregnant premenopausal uterus to facilitate gynecological procedures.
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Affiliation(s)
- Monimala Saha
- Department of Gynecology and Obstetrics, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Aparna Chakraborty
- Department of Gynecology and Obstetrics, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Sandip Chattopadhyay
- Department of Gynecology and Obstetrics, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Subhendu Saha
- Department of Pediatric Medicine, Malda Medical College, Malda, West Bengal, India
| | - Joydip Paul
- Department of Gynecology and Obstetrics, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Anjan Das
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
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Evening Primrose Oil Effect on the Ease of Cervical Ripening and Dilatation Before Operative Hysteroscopy. ACTA ACUST UNITED AC 2015. [DOI: 10.5812/thrita.29876] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Inal HA, Ozturk Inal ZH, Tonguc E, Var T. Comparison of vaginal misoprostol and dinoprostone for cervical ripening before diagnostic hysteroscopy in nulliparous women. Fertil Steril 2015; 103:1326-31. [DOI: 10.1016/j.fertnstert.2015.01.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 11/24/2022]
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23
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El-Khayat W, Dwidar L, Elsawah H, Idris O. A double-blind randomized controlled trial of two different doses of misoprostol for cervical priming prior to office hysteroscopy. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Esmaeilzadeh S, Delavar MA, Andarieh MG. Reproductive outcome following hysteroscopic treatment of uterine septum. Mater Sociomed 2014; 26:366-71. [PMID: 25685079 PMCID: PMC4314157 DOI: 10.5455/msm.2014.26.366-371] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/05/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Septate uterus is the most common uterine anomaly and a cause for miscarriage and infertility. Existing data suggested a better reproductive outcome of uterine septum following hysteroscopic septum resection. OBJECTIVE Current study was administered to share our experience in hystroscopic septum resection for reproductive outcome following hysteroscopic treatment of uterine septum and specifically focusing on different treatment protocols after hysteroscopic septum resection. METHODS& MATERIALS This study was a cross-sectional study based on secondary data that was obtained from medical records of infertile women who had undergone transvaginal hysteroscopy and used different treatment protocols after hysteroscopic correction of uterine septum in Infertility and Reproductive Health Research Center between April 2005 and February 2014. RESULTS The total number of infertile women underwent hysteroscopy uterine septoplasty was 106. The hysteroscopy septoplasty resulted in an overall pregnancy rate of 67% and a live birth 57.5%. Pregnancy rate for patients who had not male infertility was 92.1%. The chi-square test did not reveal any statistically significant difference in side affect, pregnancy, live birth, abortion, preterm deliveries, and term deliveries rate between these patients either with consistent hormone therapy plus IUD insertion or with alternate hormone therapy plus IUD after hysteroscopic metroplasty. CONCLUSION The findings of the present study indicated hysteroscopic septum resection to remove a uterine septum in women with infertility is safe and may be an efficacious procedure. Treatment following hysteroscopic septum resection, either the consistent or the alternate protocol is both beneficial to improve pregnancy rate.
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Affiliation(s)
- Seddigheh Esmaeilzadeh
- Fatemezahra Infertility and Reproductive Health Research Center, Department of Obstetrics and Gynecology, Babol University of Medical Sciences, Babol, Iran
| | - Mouloud Agajani Delavar
- Fatemezahra Infertility and Reproductive Health Research Center, Department of Midwifery, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Ghanbari Andarieh
- Fatemezahra infertility and Reproductive Health Research Center, Babol University of Medical Science, Babol, Iran
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A Randomized, Single Blind, Placebo-Controlled Trial for the Pain Reduction During the Outpatient Hysteroscopy After Ketoprofen or Intravaginal Misoprostol. J Minim Invasive Gynecol 2014; 21:921-7. [DOI: 10.1016/j.jmig.2014.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 11/30/2022]
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26
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Effectiveness of different routes of misoprostol administration before operative hysteroscopy: a randomized, controlled trial. Fertil Steril 2014; 102:519-24. [DOI: 10.1016/j.fertnstert.2014.04.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
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27
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Vaginal misoprostol for cervical priming before dilation and curettage procedures on premenopausal and postmenopausal women. ACTA ACUST UNITED AC 2013. [DOI: 10.1097/01.ebx.0000419640.39654.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Misoprostol for cervical ripening prior to gynecological transcervical procedures. Arch Gynecol Obstet 2012; 287:967-73. [PMID: 23241727 DOI: 10.1007/s00404-012-2648-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 11/15/2012] [Indexed: 10/27/2022]
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29
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Self-Administered Misoprostol or Placebo Before Intrauterine Device Insertion in Nulliparous Women. Obstet Gynecol 2012; 120:341-7. [DOI: 10.1097/aog.0b013e31825d9ec9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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30
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AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol 2012; 19:152-71. [PMID: 22381967 DOI: 10.1016/j.jmig.2011.09.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 09/08/2011] [Indexed: 11/21/2022]
Abstract
Submucous leiomyomas or myomas are commonly encountered by gynecologists and specialists in reproductive endocrinology and infertility with patients presenting with 1 or a combination of symptoms that include heavy menstrual bleeding, infertility, and recurrent pregnancy loss. There exists a variety of interventions that include those performed under hysteroscopic, laparoscopic and laparotomic direction; an evolving spectrum of image guided procedures, and an expanding number of pharmaceutical agents, each of which has value for the appropriately selected and counseled patient. Identification of the ideal approach requires the clinician to be intimately familiar with a given patient's history, including her desires with respect to fertility, as well as an appropriately detailed evaluation of the uterus with any one or a combination of a number of imaging techniques, including hysteroscopy. This guideline has been developed following a systematic review of the evidence, to provide guidance to the clinician caring for such patients, and to assist the clinical investigator in determining potential areas of research. Where high level evidence was lacking, but where a majority of opinion or consensus could be reached, the guideline development committee provided consensus recommendations as well.
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Polyzos NP, Zavos A, Valachis A, Dragamestianos C, Blockeel C, Stoop D, Papanikolaou EG, Tournaye H, Devroey P, Messinis IE. Misoprostol prior to hysteroscopy in premenopausal and post-menopausal women. A systematic review and meta-analysis. Hum Reprod Update 2012; 18:393-404. [DOI: 10.1093/humupd/dms014] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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El-Mazny A, Abou-Salem N. A double-blind randomized controlled trial of vaginal misoprostol for cervical priming before outpatient hysteroscopy. Fertil Steril 2011; 96:962-5. [DOI: 10.1016/j.fertnstert.2011.04.049] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 03/28/2011] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
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Turok DK, Espey E, Edelman AB, Lotke PS, Lathrop EH, Teal SB, Jacobson JC, Simonsen SE, Schulz KF. The methodology for developing a prospective meta-analysis in the family planning community. Trials 2011; 12:104. [PMID: 21527040 PMCID: PMC3103448 DOI: 10.1186/1745-6215-12-104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 04/29/2011] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prospective meta-analysis (PMA) is a collaborative research design in which individual sites perform randomized controlled trials (RCTs) and pool the data for meta-analysis. Members of the PMA collaboration agree upon specific research interventions and outcome measures, ideally before initiation but at least prior to any individual trial publishing results. This allows for uniform reporting of primary and secondary outcomes. With this approach, heterogeneity among trials contributing data for the final meta-analysis is minimized while each site maintains the freedom to design a specific trial. This paper describes the process of creating a PMA collaboration to evaluate the impact of misoprostol on ease of intrauterine device (IUD) insertion in nulliparous women. METHODS After the principal investigator developed a preliminary PMA protocol, he identified potential collaborating investigators at other sites. One site already had a trial underway and another site was in the planning stages of a trial meeting PMA requirements. Investigators at six sites joined the PMA collaborative. Each site committed to enroll subjects to meet a pre-determined total sample size. A final common research plan and site responsibilities were developed and agreed upon through email and face-to-face meetings. Each site committed to contribute individual patient data to the PMA collaboration, and these data will be analyzed and prepared as a multi-site publication. Individual sites retain the ability to analyze and publish their site's independent findings. RESULTS All six sites have obtained Institutional Review Board approval and each has obtained individual funding to meet the needs of that site's study. Sites have shared resources including study protocols and consents to decrease costs and improve study flow. This PMA protocol is registered with the Cochrane Collaboration and data will be analyzed according to Cochrane standards for meta-analysis. CONCLUSIONS PMA is a novel research method that improves meta-analysis by including several study sites, establishing uniform reporting of specific outcomes, and yet allowing some independence on the part of individual sites with respect to the conduct of research. The inclusion of several sites increases statistical power to address important clinical questions. Compared to multi-center trials, PMA methodology encourages collaboration, aids in the development of new investigators, decreases study costs, and decreases time to publication. TRIAL REGISTRATION ClinicalTrials.gov: NCT00613366, NCT00886834, NCT01001897, NCT01147497 and NCT01307111.
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Affiliation(s)
- David K Turok
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Alison B Edelman
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Pamela S Lotke
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
| | - Eva H Lathrop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephanie B Teal
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado, USA
| | - Janet C Jacobson
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Sara E Simonsen
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, Utah, USA
| | - Kenneth F Schulz
- Quantitative Sciences, Family Health International, Research Triangle Park, North Carolina, USA
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Sordia-Hernández LH, Rosales-Tristan E, Vazquez-Mendez J, Merino M, Iglesias JL, Garza-Leal JG, Morales A. Effectiveness of misoprostol for office hysteroscopy without anesthesia in infertile patients. Fertil Steril 2011; 95:759-61. [DOI: 10.1016/j.fertnstert.2010.07.1066] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 07/07/2010] [Accepted: 07/15/2010] [Indexed: 11/17/2022]
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35
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Clinical Use of Misoprostol in Nonpregnant Women: Review Article. J Minim Invasive Gynecol 2010; 17:449-55. [DOI: 10.1016/j.jmig.2010.03.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 03/05/2010] [Accepted: 03/12/2010] [Indexed: 01/22/2023]
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36
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Lee YY, Kim TJ, Kang H, Choi CH, Lee JW, Kim BG, Bae DS. The use of misoprostol before hysteroscopic surgery in non-pregnant premenopausal women: a randomized comparison of sublingual, oral and vaginal administrations. Hum Reprod 2010; 25:1942-8. [DOI: 10.1093/humrep/deq083] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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37
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Sublingual misoprostol for cervical ripening before diagnostic hysteroscopy in premenopausal women: A randomized, double blind, placebo-controlled trial. Fertil Steril 2010; 93:2400-4. [DOI: 10.1016/j.fertnstert.2009.01.073] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 01/09/2009] [Accepted: 01/09/2009] [Indexed: 11/18/2022]
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38
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Turok D, Simonsen SE, Schulz KF. Misoprostol for cervical priming prior to IUD insertion in nulliparous women. Hippokratia 2010. [DOI: 10.1002/14651858.cd008278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- David Turok
- University of Utah; Obstetrics and Gynecology; 30 North 1900 East Salt Lake City Utah USA UT 84132
| | - Sara Ellis Simonsen
- University of Utah; Family and Preventive Medicine; 375 Chipeta Way Salt Lake City Utah USA 84108
| | - Kenneth F Schulz
- Family Health International; Quantitative Sciences; P.O. Box 13950 Research Triangle Park North Carolina USA NC 27709
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Randomized Trial of Oral Misoprostol Before Endometrial Biopsy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:1054-1059. [DOI: 10.1016/s1701-2163(16)34351-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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40
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Lin YH, Hwang JL, Seow KM, Huang LW, Chen HJ, Hsieh BC. Laminaria tent vs misoprostol for cervical priming before hysteroscopy: Randomized study. J Minim Invasive Gynecol 2009; 16:708-12. [PMID: 19766062 DOI: 10.1016/j.jmig.2009.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 06/24/2009] [Accepted: 07/01/2009] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To compare the efficacy of laminaria tents and orally administered misoprostol in priming the cervix before operative hysteroscopy. DESIGN Randomized, controlled study (Canadian Task Force classification I). SETTING Tertiary medical center. PATIENTS One hundred twenty premenopausal women who underwent operative hysteroscopy between March 2005 and January 2007. INTERVENTION The women were randomized to receive a laminaria tent or misoprostol for cervical priming. MEASUREMENTS AND MAIN RESULTS The primary outcomes were postpriming cervical width insofar as size of Hegar dilators and need for cervical dilation. The secondary outcomes were adverse effects from the priming methods. Postpriming cervical width was greater in the laminaria group but not significantly different from that in the misoprostol group. However, cervical dilation before hysteroscopy was required in more patients in the misoprostol group. Nausea, vomiting, diarrhea, and bleeding were more common in the misoprostol group, and the incidences of chills and headache were similar between the 2 groups. CONCLUSION Laminaria tents are superior to oral misoprostol insofar as less need for cervical dilation and fewer adverse effects.
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Affiliation(s)
- Yu-Hung Lin
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Current World Literature. Curr Opin Obstet Gynecol 2009; 21:353-63. [DOI: 10.1097/gco.0b013e32832f731f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Valente EP, de Amorim MMR, Costa AAR, de Miranda DV. Vaginal Misoprostol Prior to Diagnostic Hysteroscopy in Patients of Reproductive Age: A Randomized Clinical Trial. J Minim Invasive Gynecol 2008; 15:452-8. [DOI: 10.1016/j.jmig.2008.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Revised: 04/03/2008] [Accepted: 04/04/2008] [Indexed: 11/25/2022]
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