{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:56:01Z","timestamp":1791618961643,"version":"4.3.4"},"reference-count":46,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2024,9,17]],"date-time":"2024-09-17T00:00:00Z","timestamp":1726531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"DFG"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Hysteroscopy has been used as both a diagnostic and therapeutic tool for intrauterine pathologies under direct visualization. However, this procedure may be associated with an increased risk of complications during entry, which can be reduced by cervical ripening before the operation. The efficacy of misoprostol in this context is influenced by factors such as estrogen levels, parity, and the mode of previous deliveries. This study aimed to assess the efficacy and safety of misoprostol in women with a challenging cervix while mitigating the influence of confounding variables. Methods: Three electronic databases, namely PubMed, Scopus, and ISI Web of Science, were searched until 14 May 2024. Randomized controlled trials focusing on postmenopausal patients, nulliparous women, and multiparous women with no prior history of vaginal delivery, undergoing hysteroscopy were included. The cervical width, time needed for cervical dilation, and the need for additional dilatation alongside the complications and adverse effects from all included studies were collected and analyzed using R (version 4.2.3). Results: Seven studies on premenopausal women and three on postmenopausal women were included. In premenopausal women, misoprostol significantly increased cervical width compared to placebo (SMD = 2.2, 95% CI 0.9 to 3.4) and reduced the need for additional cervical dilatation (OR = 0.36, 95% CI 0.17 to 0.74). No significant difference was found in the time required for cervical dilation between misoprostol and placebo groups. In postmenopausal women, misoprostol did not significantly affect cervical width compared to placebo (SMD = \u22120.55, 95% CI \u22121.3 to 0.21). Conclusions: Misoprostol is beneficial for cervical dilation in premenopausal women without a prior history of vaginal delivery but less effective in postmenopausal patients. While associated with postoperative risks, it reduces hysteroscopy-related complications. Future research should address discrepancies by controlling the confounding variables like menopausal status, parity, and mode of delivery to enhance the understanding of misoprostol\u2019s effects and pinpoint the specific patient populations that would derive the greatest benefits from its use.<\/jats:p>","DOI":"10.3390\/jcm13185494","type":"journal-article","created":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T01:16:10Z","timestamp":1726622170000},"page":"5494","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Assessing the Efficacy and Safety of Misoprostol Prior to Hysteroscopy in Women with Difficult Cervix: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"13","author":[{"given":"Atieh","family":"Karimzadeh","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9851-6771","authenticated-orcid":false,"given":"Leila","family":"Allahqoli","sequence":"additional","affiliation":[{"name":"Ministry of Health and Medical Education, Tehran 1435713715, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid","family":"Salehiniya","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soheil","family":"Hanjani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Good Samaritan Medical Center, Brockton, MA 02301, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghazal","family":"Namavari","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3083-1457","authenticated-orcid":false,"given":"Abbas","family":"Fazel Anvari-Yazdi","sequence":"additional","affiliation":[{"name":"Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Dr, Saskatoon, SK S7K 5A9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kobra","family":"Tahermanesh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7194-6034","authenticated-orcid":false,"given":"Ibrahim","family":"Alkatout","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/s40477-022-00732-w","article-title":"Additional Value of Doppler Ultrasound to B-Mode Ultrasound in Assessing for Uterine Intracavitary Pathologies among Perimenopausal and Postmenopausal Bleeding Women: A Multicentre Prospective Observational Study in Vietnam","volume":"26","author":"Nguyen","year":"2023","journal-title":"J. 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Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/18\/5494\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:57:51Z","timestamp":1760111871000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/18\/5494"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,17]]},"references-count":46,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["jcm13185494"],"URL":"https:\/\/doi.org\/10.3390\/jcm13185494","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,17]]}}}