TY - JOUR
T1 - Vaginal dinoprostone versus placebo for pain relief during intrauterine device insertion
T2 - a systematic review and meta-analysis of randomised controlled trials
AU - Abu-Zaid, Ahmed
AU - Alshahrani, Majed S.
AU - Albezrah, Nisreen A.
AU - Miski, Najlaa T.
AU - Abuzaid, Mohammed
AU - Aboudi, Saud A.
AU - Baredwan, Ahlam
AU - Almadhi, Nada
AU - Baradwan, Afnan
AU - Alomar, Osama
AU - Salem, Hany
AU - A. Al-Badawi, Ismail
AU - Baradwan, Saeed
N1 - Publisher Copyright:
© 2021 The European Society of Contraception and Reproductive Health.
PY - 2021
Y1 - 2021
N2 - Objective: To systematically and meta-analytically investigate the efficacy and safety of vaginal dinoprostone versus placebo in pain relief during intrauterine device (IUD) insertion. Methods: PubMed, Scopus, Web of Science, and Cochrane Library were screened till 1 October 2020. Only randomised placebo-controlled studies were included and assessed for risk of bias. Main outcomes included IUD insertion related pain, patient satisfaction, provider ease of IUD insertion, and side effects. Pooled outcomes were summarised as standardised mean difference (SMD), weighted mean difference (WMD), or risk ratio (RR) with 95% confidence interval (95% CI). Results: Five studies were included, comprising 862 patients; equally 431 patients received vaginal dinoprostone and placebo. All studies showed an overall low risk of bias. When compared to placebo, dinoprostone significantly correlated with decreased pain at tenaculum placement (SMD = −0.79, 95% CI [−1.43, −0.16], p = 0.01), decreased pain at uterine sounding (SMD = −0.88, 95% CI [−1.54, −0.22], p = 0.009), decreased pain at IUD insertion (SMD = −1.18, 95% CI [−1.74, −0.61], p < 0.001), decreased need for additional analgesia (RR = 0.34, 95% CI [0.22, 0.53], p < 0.001), increased patient satisfaction (SMD = 1.41, 95% CI [0.62, 2.20], p < 0.001), and increased provider ease of IUD insertion (SMD = −1.17, 95% CI [−1.62, −0.73], p < 0.001). Fever was statistically significantly higher in dinoprostone versus placebo group (RR = 3.73, 95% CI [1.47, 9.44], p = 0.006). All other side effects—including nausea, vomiting, shivering, diarrhoea, abdominal cramps, vasovagal attack, uterine perforation, and postprocedural bleeding—did not substantially differ between both groups. Conclusions: This first ever meta-analysis advocates that dinoprostone compared with placebo is safe, effective, and yields favourable analgesic outcomes during IUD insertion.
AB - Objective: To systematically and meta-analytically investigate the efficacy and safety of vaginal dinoprostone versus placebo in pain relief during intrauterine device (IUD) insertion. Methods: PubMed, Scopus, Web of Science, and Cochrane Library were screened till 1 October 2020. Only randomised placebo-controlled studies were included and assessed for risk of bias. Main outcomes included IUD insertion related pain, patient satisfaction, provider ease of IUD insertion, and side effects. Pooled outcomes were summarised as standardised mean difference (SMD), weighted mean difference (WMD), or risk ratio (RR) with 95% confidence interval (95% CI). Results: Five studies were included, comprising 862 patients; equally 431 patients received vaginal dinoprostone and placebo. All studies showed an overall low risk of bias. When compared to placebo, dinoprostone significantly correlated with decreased pain at tenaculum placement (SMD = −0.79, 95% CI [−1.43, −0.16], p = 0.01), decreased pain at uterine sounding (SMD = −0.88, 95% CI [−1.54, −0.22], p = 0.009), decreased pain at IUD insertion (SMD = −1.18, 95% CI [−1.74, −0.61], p < 0.001), decreased need for additional analgesia (RR = 0.34, 95% CI [0.22, 0.53], p < 0.001), increased patient satisfaction (SMD = 1.41, 95% CI [0.62, 2.20], p < 0.001), and increased provider ease of IUD insertion (SMD = −1.17, 95% CI [−1.62, −0.73], p < 0.001). Fever was statistically significantly higher in dinoprostone versus placebo group (RR = 3.73, 95% CI [1.47, 9.44], p = 0.006). All other side effects—including nausea, vomiting, shivering, diarrhoea, abdominal cramps, vasovagal attack, uterine perforation, and postprocedural bleeding—did not substantially differ between both groups. Conclusions: This first ever meta-analysis advocates that dinoprostone compared with placebo is safe, effective, and yields favourable analgesic outcomes during IUD insertion.
KW - Dinoprostone
KW - intrauterine device
KW - pain relief
KW - placebo
UR - http://www.scopus.com/inward/record.url?scp=85102530371&partnerID=8YFLogxK
U2 - 10.1080/13625187.2021.1891411
DO - 10.1080/13625187.2021.1891411
M3 - Article
C2 - 33691549
AN - SCOPUS:85102530371
SN - 1362-5187
VL - 26
SP - 357
EP - 366
JO - European Journal of Contraception and Reproductive Health Care
JF - European Journal of Contraception and Reproductive Health Care
IS - 5
ER -
