title: A systematic review and meta-analysis of randomized studies comparing misoprostol versus placebo for cervical ripening prior to hysteroscopy.
abstract: OBJECTIVE
  Hysteroscopy is an effective method for examining the uterine cavity but has some limitations, including the occasional need for cervical dilatation. Misoprostol is routinely used for cervical dilatation in various procedures but has not gained wide acceptance for use before hysteroscopy.
  
  
  METHODS
  This review includes randomized controlled trials which compare the use of misoprostol versus placebo by different routes and doses before diagnostic or operative hysteroscopy. The MEDLINE database and the Cochrane Central Register of Controlled Trials were searched for articles published from January 1970 to April 2010. The outcome measures studied were related either to the facilitation of the hysteroscopic procedure (need for cervical dilatation, cervical width at the beginning of hysteroscopy, duration of the procedure and complications such as cervical tear and uterine perforation) or to the medication side-effects. With regard to side-effects, we studied the incidence of nausea, diarrhea, abdominal pain, bleeding, and fever.
  
  
  RESULTS
  Vaginal misoprostol reduced the need for cervical dilatation in the total population of pre- and post-menopausal women to a statistically significant degree. In the subgroup of operative hysteroscopy the need for dilatation and the duration of the procedure were also significantly reduced. Most other outcomes relating to the facilitation of the procedure did not reach statistical significance. The side effects in the misoprostol group were significantly more frequent than in the placebo group.
  
  
  CONCLUSIONS
  There is insufficient evidence to recommend the routine use of misoprostol before every hysteroscopy. As the lack of serious benefit from misoprostol is unlikely to be due to type II error, its use should be reserved for selected cases.
authors.affiliation: Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Fani
authors.initials: F
authors.lastname: Gkrozou
authors.forename: George
authors.initials: G
authors.lastname: Koliopoulos
authors.forename: Thomas
authors.initials: T
authors.lastname: Vrekoussis
authors.forename: George
authors.initials: G
authors.lastname: Valasoulis
authors.forename: Lazaros
authors.initials: L
authors.lastname: Lavasidis
authors.forename: Iordanis
authors.initials: I
authors.lastname: Navrozoglou
authors.forename: Minas
authors.initials: M
authors.lastname: Paschopoulos
mesh_terms: D002584:Cervix Uteri / Q000187:drug effects*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D010120:Oxytocics; D016595:Misoprostol