A systematic review and meta-analysis of randomized controlled trials on the effectiveness of cervical ripening with misoprostol administration before hysteroscopy.

Background: Misoprostol is an effective cervical ripening agent.

Objective: To determine the effect of misoprostol on cervical ripening before hysteroscopy.

Methods: Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched for pertinent studies published before November 2014, using the search terms "hysteroscopy," "ripening," and "misoprostol." Methods: Randomized controlled trials published in English were included that compared the effects of misoprostol versus placebo on cervical dilatation before diagnostic or operative hysteroscopy. Methods: Random-effects models were used to calculate odds ratios or mean differences (MDs) with 95% confidence intervals (CIs).

Results: The analysis included 32 trials. Misoprostol had significant effects on the need for further cervical dilatation (odds ratio 0.29, 95% CI 0.17-0.50), the cervical width (MD 1.53, 95% CI 0.92-2.13), and the time taken for cervical dilatation (MD -0.35, 95% CI -0.50 to -0.20). Corresponding observations were made in the subgroup of premenopausal women, but not in the subgroup of postmenopausal women. Adverse effects were significantly more common with misoprostol than with placebo (risk difference 0.07, 95% CI 0.01-0.12).

Conclusions: Misoprostol had a significant effect on cervical ripening before hysteroscopy, except in the postmenopausal population. However, it also resulted in more adverse effects.