Cervical dilatation and preparation prior to outpatient hysteroscopy: a systematic review and meta-analysis.

BJOG : an International Journal of Obstetrics and Gynaecology
Prathiba M De SilvaT J Clark

Abstract

There are uncertainties about the benefit of routine cervical preparation and/or cervical dilatation before outpatient hysteroscopy. To determine if cervical preparation and/or routine mechanical dilatation reduces pain during outpatient hysteroscopy. MEDLINE, EMBASE, CINAHL and CENTRAL were searched on 19 October 2020, using keywords 'hysteroscopy', 'cervical preparation', 'cervical ripening', 'cervical dilatation', 'outpatient', 'office' and/or 'ambulatory' and associated medical subject headings. Randomised controlled trials investigating the benefit of cervical preparation and/or cervical dilatation on pain in women undergoing outpatient hysteroscopy were included. Two independent reviewers selected eligible trials and extracted data on pain, feasibility, adverse events and satisfaction/acceptability for meta-analysis. The literature search yielded 807 records, of which 24 were included for review and 19 provided data for meta-analysis. No trials investigated the role of routine mechanical cervical dilatation. Cervical preparation significantly reduced pain during outpatient hysteroscopy; standard mean difference (SMD) -0.67, 95% confidence interval (CI) -1.05 to -0.29. Feasibility also improved as priming provided signific...Continue Reading

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