Vaginal dinoprostone versus placebo for pain relief during intrauterine device insertion: a systematic review and meta-analysis of randomized controlled trials

Abstract

AbstractObjectiveTo investigate the safety and efficacy of vaginal dinoprostone versus placebo in pain relief during intrauterine device (IUD) insertion.DesignSystematic review and meta-analysis of randomized placebo-controlled trials.SettingNot applicable.Patient(s)Women undergoing IUD insertion and receiving vaginal dinoprostone or placebo.Intervention(s)PubMed, Scopus, Web of Science, and Cochrane Library were screened from inception to 01-October-2020, using the following search strategy: (dinoprostone OR cervidil OR prepidil) AND (intrauterine device OR iud).Main outcome measure(s)IUD insertion related pain, patient satisfaction, provider ease of IUD insertion, and side effects.Result(s)Five studies met the study inclusion criteria, comprising 862 patients; equally 431 patients received vaginal dinoprostone and placebo. All studies had 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, diarrhea, abdominal cramps, vasovagal attack, uterine perforation, and postprocedural bleeding—did not substantially differ between both groups.ConclusionsThis first ever meta-analysis advocates that dinoprostone is safe, effective, and yields favorable analgesic outcomes during IUD insertion.