title: Vaginal Misoprostol for Overcoming Inadequate Colposcopies: A Meta-analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  Inadequate colposcopic results due to inadequate visualization of the cervical transformation zone is a diagnostic problem that is encountered in approximately 10% to 15% of these procedures. The objective of the present systematic review and meta-analysis was to investigate whether misoprostol effectively converts inadequate colposcopic examinations to adequate.
  
  
  METHODS
  We searched MEDLINE (1966-2014), Scopus (2004-2014), Popline (1974-2014), ClinicalTrials.gov (2008-2014), CENTRAL (1999-2014), and Google Scholar (2004-2014) search engines along with reference lists of all electronically retrieved articles. For the meta-analysis of selected indices, we used the RevMan 5.2 program.
  
  
  RESULTS
  Treatment with misoprostol significantly increases the rates of adequate colposcopic examinations (odds ratio [OR] = 6.78, 95% confidence interval [CI] = 2.94-15.61). Its principal adverse effect is abdominal pain (OR = 10.19, 95% CI = 2.19-47.45). Neither nausea (105 women, random effects model [REM], OR = 4.99, 95% CI = 0.54-45.71) nor fever (111 women, REM, OR = 3.90, 95% CI = 0.59-25.56) or diarrhea (111 women, REM, OR = 2.21, 95% CI = 0.49-10.00) was found increased among women receiving misoprostol. The conversion rates toward an adequate examination ranged between 55.5% and 78.9% in the misoprostol group.
  
  
  CONCLUSIONS
  According to our meta-analysis, misoprostol seems to improve the conversion rates from inadequate colposcopic examinations to adequate diagnoses. However, firm results to generalize our findings among specific populations, such as those already having a previous conization, are precluded by the small number of enrolled studies. Thus, future research in the field becomes necessary.
authors.affiliation: 1Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, 21st Department of Obstetrics and Gynecology, and 33rd Department of Obstetrics and Gynecology, Athens University, Medical School, Alexandra Hospital, Athens, Greece.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Pergialiotis
authors.forename: Dimitrios-Efthymios
authors.initials: DE
authors.lastname: Vlachos
authors.forename: Eleni
authors.initials: E
authors.lastname: Pitsouni
authors.forename: Despina
authors.initials: D
authors.lastname: Perrea
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Vlachos
mesh_terms: D003127:Colposcopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000494:pharmacology*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014621:Vagina / Q000187:drug effects*
chemical_list: D016595:Misoprostol