Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt.
, 11 Eid Mostafa Street, Haram, Giza, 12111, Egypt.
BMC Pregnancy Childbirth. 2024 Nov 27;24(1):796. doi: 10.1186/s12884-024-06993-z.
To assess the value of misoprostol intake before hysteroscopy in nulliparous women.
Databases screening was done from inception to July 2023 using "Misoprostol" AND "Hysteroscopy" AND "Nullipara" and their MeSH terms as keywords.
Thirteen studies were included in our analysis. Seven studies compared misoprostol to placebo, 3 studies compared it to dinoglandin, 1 study compared it to diclofenac and 4 studies compared different misoprostol doses and routes. These studies were conducted on 1528 participants,958 of them received misoprostol, 221 received dinoglandin, 51 received diclofenac and 308 received placebo.
Extracted data included study place, participants number, inclusion and exclusion criteria, intervention details as dose, route, timing and comparotor, and hysteroscopy details.
Ease of cervical dilatation was reported in 3 studies (309 participants) and revealed an effect estimate mean difference (MD) of -0.57 [-1.72, 0.58] and a P value of 0.33. The time needed for cervical dilatation was reported in 6 studies (512 participants) and revealed a MD of -22.96 [-43.29, -2.62] and a P value of 0.03. The preoperative cervical width was reported in 4 studies (263 participants) and revealed MD of 1.69 [-0.09, 3.46] and a P value of 0.06. The number of women with failure of cervical dilatation or who needed further dilatation was reported in 4 studies (372 participants) and revealed a MD of 0.40 with [0.13, 1.17] 95% CI and a P value of 0.09. The preoperative pain was reported in 3 studies (351 participants) and revealed a MD of -0.56 [-2.30, 1.18] and a P value of 0.53. Total number of cases who experienced side effects and procedure complications were reported in 2 and 3 studies (249 and 252 participants) respectively and revealed an effect estimate Odd Ratio of 1.99 and 0.42 with [0.27, 14.67] and [0.14,1.32] 95% CI and a P value of 0.50 and 0.14 respectively. In the 3 studies comparing misoprostol to dinoglandin, The ease of cervical dilatation, time needed for cervical dilatation and preoperative cervical width were evaluated in 1,3 and 2 studies with 60, 436 and 376 participants respectively. The estimated MD were not estimated, 0.17 and 0.01; 95% CI were not estimated, [-4.70, 5.05], and [-0.78, 0.79]; P values of 0.94, 0.98 and 0.99 and I of 96%,95% and 74% respectively.
Misoprostol improved the time needed for cervical dilatation without affecting the rate of complications or drug side effects when compared to placebo but has similar outcomes to dinoglandin with higher side effects.
CRD42023438432.
评估米索前列醇在经阴道子宫镜检查前在初产妇中的应用价值。
从创建到 2023 年 7 月，使用“米索前列醇”和“子宫镜检查”和“初产妇”及其 MeSH 术语作为关键词，对数据库进行了筛选。
纳入的 13 项研究进行了分析。7 项研究比较了米索前列醇与安慰剂，3 项研究比较了米索前列醇与 dinoglandin，1 项研究比较了米索前列醇与双氯芬酸，4 项研究比较了不同剂量和途径的米索前列醇。这些研究共纳入了 1528 名参与者，其中 958 名接受了米索前列醇，221 名接受了 dinoglandin，51 名接受了双氯芬酸，308 名接受了安慰剂。
提取的数据包括研究地点、参与者数量、纳入和排除标准、干预措施的详细信息，如剂量、途径、时间和比较器以及子宫镜检查的详细信息。
3 项研究（309 名参与者）报告了宫颈扩张的难易程度，结果显示估计的平均差异（MD）为-0.57 [-1.72, 0.58]，P 值为 0.33。6 项研究（512 名参与者）报告了宫颈扩张所需的时间，结果显示 MD 为-22.96 [-43.29, -2.62]，P 值为 0.03。4 项研究（263 名参与者）报告了术前宫颈宽度，结果显示 MD 为 1.69 [-0.09, 3.46]，P 值为 0.06。4 项研究（372 名参与者）报告了宫颈扩张失败或需要进一步扩张的妇女人数，结果显示 MD 为 0.40 [0.13, 1.17] 95% CI，P 值为 0.09。3 项研究（351 名参与者）报告了术前疼痛，结果显示 MD 为-0.56 [-2.30, 1.18]，P 值为 0.53。2 项和 3 项研究（249 名和 252 名参与者）分别报告了发生不良反应和手术并发症的总病例数，结果显示估计的优势比为 1.99 和 0.42，95% CI 分别为[0.27, 14.67]和[0.14,1.32]，P 值分别为 0.50 和 0.14。在 3 项比较米索前列醇与 dinoglandin 的研究中，1 项研究评估了宫颈扩张的难易程度，3 项研究评估了宫颈扩张所需的时间，2 项研究评估了术前宫颈宽度，分别有 60、436 和 376 名参与者。未估计估计的 MD 分别为 0.17 和 0.01；未估计 95% CI 分别为[-4.70, 5.05]和[-0.78, 0.79]；P 值分别为 0.94、0.98 和 0.99，I 分别为 96%、95%和 74%。
与安慰剂相比，米索前列醇可改善宫颈扩张所需的时间，而不影响并发症或药物副作用的发生率，但与 dinoglandin 具有相似的结果，且副作用更高。
CRD42023438432。
