Cervical preparation for second trimester dilation and evacuation

Cervical preparation for second trimester dilation and

evacuation (Review)

Newmann SJ Dalve-Endres A Diedrich JT Steinauer JE Meckstroth K Drey EA

This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library

2010 Issue 8

httpwwwthecochranelibrarycom

Cervical preparation for second trimester dilation and evacuation (Review)

Copyright copy 2010 The Cochrane Collaboration Published by John Wiley amp Sons Ltd

T A B L E O F C O N T E N T S

1HEADER

1ABSTRACT

2PLAIN LANGUAGE SUMMARY

3BACKGROUND

4OBJECTIVES

4METHODS

5RESULTS

Figure 1 7

Figure 2 8

Figure 3 8

Figure 4 9

Figure 5 9

Figure 6 10

Figure 7 10

Figure 8 10

Figure 9 10

Figure 10 11

Figure 11 11

Figure 12 11

Figure 13 12

Figure 14 12

Figure 15 12

Figure 16 13

Figure 17 13

Figure 18 13

Figure 19 13

Figure 20 14

Figure 21 14

Figure 22 14

Figure 23 14

Figure 24 15

Figure 25 15

Figure 26 15

16DISCUSSION

17AUTHORSrsquo CONCLUSIONS

17ACKNOWLEDGEMENTS

18REFERENCES

19CHARACTERISTICS OF STUDIES

26DATA AND ANALYSES

Analysis 11 Comparison 1 Osmotic Dilators vs Prostaglandins Outcome 1 Initial Dilation (mm) 28

Analysis 12 Comparison 1 Osmotic Dilators vs Prostaglandins Outcome 2 Difficult Dilation 28

Analysis 21 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 1 Procedure TIme 29

Analysis 22 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 2 Need for Additional dilation 29

Analysis 23 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 3 Nausea 30

Analysis 24 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 4 Vomiting 30

Analysis 25 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 5 Diarrhea 31

Analysis 26 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 6 Fevers 31

Analysis 27 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 7 Chills 32

Analysis 31 Comparison 3 Hypan vs Gemeprost (15-20 weeks) Outcome 1 Spotting 32

Analysis 32 Comparison 3 Hypan vs Gemeprost (15-20 weeks) Outcome 2 Pain 33

Analysis 41 Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) Outcome 1 Procedure Time 33

iCervical preparation for second trimester dilation and evacuation (Review)


Analysis 42 Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) Outcome 2 Initial Dilation (mm) 34

Analysis 43 Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) Outcome 3 Difficult Dilation ( yes) 34

Analysis 44 Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) Outcome 4 Cramps after cervical

preparation 35

Analysis 45 Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) Outcome 5 Need for Additional Dilation

( yes) 35

Analysis 51 Comparison 5 Misoprostol (vaginal or sub-lingual) Alone vs Misoprostol (vaginal or sub-lingual) and

Mifepristone (14-20 weeks) Outcome 1 Initial Dilation (mm) 36


Mifepristone (14-20 weeks) Outcome 2 Need for Additional Dilation 36


Mifepristone (14-20 weeks) Outcome 3 Procedure time (min) 37


Mifepristone (14-20 weeks) Outcome 4 GI effects (nausea vomiting diarrhea) 37


Mifepristone (14-20 weeks) Outcome 5 Spotting 38


Mifepristone (14-20 weeks) Outcome 6 Pre-procedural Expulsion Abortion 38

Analysis 61 Comparison 6 Laminaria vs Lamicel (14-16 weeks) Outcome 1 Need for dilation beyond 37 French units 39

Analysis 62 Comparison 6 Laminaria vs Lamicel (14-16 weeks) Outcome 2 Adequate Initial Dilation (gt or = 37 French

units) 39

Analysis 71 Comparison 7 One- vs Two-Day Laminaria Placement (17-19 weeks) Outcome 1 Procedure Time (min) 40

Analysis 72 Comparison 7 One- vs Two-Day Laminaria Placement (17-19 weeks) Outcome 2 Initial Dilation (mm) 40

40HISTORY

41CONTRIBUTIONS OF AUTHORS

41DECLARATIONS OF INTEREST

41SOURCES OF SUPPORT

42DIFFERENCES BETWEEN PROTOCOL AND REVIEW

42NOTES

42INDEX TERMS

iiCervical preparation for second trimester dilation and evacuation (Review)


[Intervention Review]

Cervical preparation for second trimester dilation andevacuation

Sara J Newmann1 Andrea Dalve-Endres2 Justin T Diedrich3 Jody E Steinauer2 Karen Meckstroth2 Eleanor A Drey2

1Obstetrics and Gynecology and Reproductive Sciences University of California San Francisco General Hospital San Francisco

California USA 2Obstetrics Gynecology and Reproductive Sciences University of California San Francisco San Francisco CA

USA 3Obstetrics and Gynecology and Office of Medical Education University of California Irvine Irvine CA USA

Contact address Sara J Newmann Obstetrics and Gynecology and Reproductive Sciences University of California San Francisco

General Hospital 1001 Potrero Avenue Ward 6D San Francisco California CA 94110 USA newmannsobgynucsfedu

Editorial group Cochrane Fertility Regulation Group

Publication status and date New published in Issue 8 2010

Review content assessed as up-to-date 16 April 2008

Citation Newmann SJ Dalve-Endres A Diedrich JT Steinauer JE Meckstroth K Drey EA Cervical preparation for sec-

ond trimester dilation and evacuation Cochrane Database of Systematic Reviews 2010 Issue 8 Art No CD007310 DOI

10100214651858CD007310pub2


A B S T R A C T

Background

Abortion during the second trimester of pregnancy accounts for 10-15 of abortions performed worldwide Dilation and evacuation

(DampE) is the preferred method of second-trimester abortion in most parts of the developed world Cervical preparation is recommended

for dilation and curettage (DampC) after 12 weeks gestation and is standard practice for DampE beyond 14 weeks gestation Prostaglandins

osmotic dilators and Foley balloon catheters have been used and studied as cervical preparation prior to second-trimester DampE

However no consensus exists as to which cervical preparation method is superior with regards to safety procedure time need for

additional dilation ability to perform the procedure or patient and provider acceptability Despite the fact that the advent of osmotic

dilation has improved the safety of the DampE procedure during the second trimester it is unclear whether a certain type of osmotic

dilator is superior to another or whether osmotic dilation with adjuvant prostaglandin is superior to osmotic dilation alone or to

prostaglandins alone

Objectives

This review evaluates cervical preparation methods for second-trimester surgical abortion with respect to differences in procedure time

dilation achieved need for additional dilation complications ability to complete the procedure patient pain scores and patient and

provider acceptability and satisfaction

Search strategy

We searched for trials of cervical preparation prior to second-trimester DampE

Selection criteria

We included all randomized controlled trials that compared osmotic mechanical antiprogesterone prostaglandin or other medical

agents of cervical preparation for second-trimester surgical abortion from 14-24 weeks of gestation

Data collection and analysis

Data were abstracted by two authors and data entry was verified by a third author Mean difference and Peto Odds Ratio were calculated

1Cervical preparation for second trimester dilation and evacuation (Review)


Main results

Osmotic dilators were found to be superior to prostaglandins with respect to cervical dilation throughout the second trimester and

with respect to procedure time within the early second trimester Addition of prostaglandins to osmotic dilators was not found to

increase cervical dilation except after 19 weeks gestation however no impact was seen on procedure time Addition of Mifepristone

to misoprostol was found to improve cervical dilation yet increase procedure time and frequency of pre-procedural expulsions Two-

day cervical preparation was found to produce greater cervical preparation than one-day but had no impact on procedure time Serious

complication rates or ability to complete the procedure did not differ significantly between any of the preparation methods reviewed

Authorsrsquo conclusions

Cervical preparation with osmotic dilators andor misoprostol before second-trimester DampE is safe and effective Osmotic dilators

appear to provide superior cervical dilation when compared to prostaglandins alone or when combined with prostaglandins however

this difference in cervical dilation does not appear to result in differences in procedure time or complication rates There does not

appear to be clear clinical benefit from two days of cervical preparation compared to one-day prior to second-trimester DampE below

19 weeks gestational duration Mifepristone plus misoprostol was associated with high rates of pre-procedural expulsions and does not

appear to be a useful method of cervical preparation before second-trimester dilation and evacuation Same-day procedures appear to

be a safe and reasonable option in the early second trimester however more research is needed to assess the effectiveness and safety of

same-day procedures in the later second trimester

P L A I N L A N G U A G E S U M M A R Y

Preparation of the uterine cervix before evacuation of second-trimester pregnancy

Abortion during the second trimester of pregnancy accounts for 10-15 of abortions performed worldwide (Finer 2005 Stat Service

2005 WHO 1997) Surgical evacuation called dilation and evacuation (DampE) is the preferred method of second-trimester abortion

as opposed to induction of labor in most developed countries where DampE and medical methods are both available (Lohr 2008 RCOG

2004) In order to perform a DampE surgical instruments must pass through the cervix the opening to the uterus into the uterus In

order for these instruments to pass through the cervix safely the cervix must be opened prior to the procedure This process of opening

the cervix prior to a DampE is called cervical preparation and can be done with medications or with small rod-like devices that are placed

inside the cervix The most commonly used medications for cervical preparation are called prostaglandins These medications can be

taken orally or placed in the vagina or the cheeks and need to be taken several hours before the procedure They work by softening

thinning and opening the cervix so that at the time of the procedure it is possible to further open the cervix if needed and to place the

instruments through the cervix into the body of the uterus The small-rod like devices used for cervical preparation are called cervical

dilators Dilators are placed inside the cervix several hours before the procedure or even a day or two before the procedure In general

dilators work by absorbing moisture from the cervix which causes the dilators to swell and get larger As the diameter of these dilators

expands the dilator puts radial pressure on the cervical walls and causes the cervix to open

There are many options of what to use for cervical preparation before a second-trimester DampE These methods have different side

effects and take varying amounts of time from about four hours prior to the procedure to two days before Since there is no clear

consensus as to what cervical preparation method is best for preparing the cervix for a second-trimester DampE we reviewed all published

randomized trials that compared different methods of cervical preparation before second-trimester DampE defined as between 14 and

24 weeks of pregnancy

We did computer searches for all published randomized trials that compared different methods of cervical preparation before second-

trimester DampE and we found six studies that met our criteria All of the methods compared were different from one another thus it

was not possible to combine data from multiple studies We looked at how these preparation methods compared with respect to safety

procedure time need for additional dilation ability to perform the procedure and patient and provider acceptability

We found that all methods reviewed were safe Certain dilators called laminaria appeared to result in more cervical opening (dilation)

than the prostaglandin medications however no difference was seen between dilators and prostaglandins with respect to safety length

of procedure or the ability to complete the procedure We found that when mifepristone a medication that blocks the action of a

hormone called progesterone was used with a prostaglandin called misoprostol that many women ended up expelling the pregnancy

before their desired surgical procedure Due to this increased rate of expulsions prior to planned DampE we feel that the combination

of mifepristone and misoprostol should not be used for cervical preparation when women are desiring a surgical procedure instead of



an induction We found that one day of cervical preparation is just a good as two days and that same-day cervical preparation appears

to be safe in the early part of the second trimester

We believe that more research is needed in the area of same-day cervical preparation as it is much easier for women to have a one-day

instead of a multiple day procedure We also think more research is needed in the area of combining prostaglandins with dilators as

this may improve the possibility of conducting same-day procedures later into the second trimester

B A C K G R O U N D

Abortion during the second trimester of pregnancy accounts for

10-15 of abortions performed worldwide (Finer 2005 Stat

Service 2005 WHO 1997) Dilation and evacuation (DampE) is

the preferred method of second-trimester abortion in most devel-

oped countries where DampE and medical methods are both avail-

able (Lohr 2008 RCOG 2004) Cervical preparation is recom-

mended for dilation and curettage (DampC)over 9 completed weeks

gestational duration for nulliparous women for women younger

than 18 years old and for all women with durations of pregnancy

over 12 completed weeks (WHO 2003 RCOG 2004) Cerival

preparation is deemed essential for DampE between 14 weeks ges-

tation and beyond (Fox 2007 Newmann 2008) Prostaglandins

osmotic dilators and Foley balloon catheters have been used and

studied as cervical preparation prior to second-trimester DampE

(Carbonell 2007 Goldberg 2005 Hackett 1989 Hern 1994

Lichtenberg 2004 Patel 2006 Todd 2002) However no clear

consensus exists as to which cervical preparation method is su-

perior with regards to safety procedure time need for additional

dilation ability to perform the procedure or patient and provider

acceptability

Osmotic dilators exist in three main forms laminaria tents

LamicelT M and Dilapan-ST M Laminaria tents are dried com-

pressed seaweed stems that absorb fluid and gradually expand

providing both mechanical dilation and dilation from endoge-

nous prostaglandin release (Herczeg 1986) While laminaria do

not achieve full dilation potential for 12-24 hours a clinical ef-

fect is measurable after three hours (Eaton 1972 Krammer 1995

Newton 1972) Reports of laminaria use date back to 1862 giv-

ing laminaria a long record of successful dilation with an excellent

safety profile (Bierer 1972 Eaton 1972)

DilapanT M a hygroscopic dilator rod made from hydrophilic

polymers was used in abortion procedures in 1982 (Chvapil 1982)

but felt to be inferior to laminaria due to reports of fragmentation

(Hern 1994 Lichtenberg 2004) Similar to laminaria DilapanT M

works by producing an outward mechanical force in addition to

prostaglandin release causing collagen degradation that leads to

cervical softening (FEMA 2003) In 2002 Dilapan-ST M a revised

formula became available for use in the US Problems with frag-

mentation have not been reported with Dilapan-ST M and it is es-

timated to exert close to its maximum effect within 4-6 hours but

continues to expand for up to 24 hours (FEMA 2003)

LamicelT M a sterile polyvinyl alcohol sponge impregnated with

magnesium sulfate notably does not elicit cervical wall tension In

contrast to laminaria and DilapanT M its action is largely chemical

While product claims are made that it softens the cervix in 30

minutes and will dilate the cervix adequately in a few hours it may

not achieve adequate dilation alone for procedures greater than 20

weeks gestation (Darney 1986)

Prostaglandins were first noted in 1970 to be capable of softening

and dilating the cervix before uterine evacuation (Behrman 2007

Kalish 2002 Karim 1971 Wiquist 1970) Due to low cost and

chemical stability misoprostol a PGE1 analogue has become the

most commonly used prostaglandin analogue (RCOG 2004) Re-

search is inconclusive regarding misoprostol as a sole or adjunc-

tive method of cervical preparation for second-trimester abortion

Research suggests that solitary use of misoprostol before second-

trimester abortion is inferior to the use of osmotic dilators alone

with respect to cervical dilation but differences in safety of and

ability to complete the procedure have not been found (Goldberg

2005 Patel 2006 Poon 2007) Research suggests that in conjunc-

tion with osmotic dilators misoprostol may improve cervical di-

lation (Fox 2007 Newmann 2008 Poon 2007)

Cervical laceration with possible resultant hemorrhage is one of

the most commonly cited serious DampE complications (Altman

1985 Darney 1986 Grimes 1984 Krammer 1995 Munsick

1996 Schulz 1983) A review of 12000 patients undergoing Damp

E between 12-26 weeks found cervical laceration to be the most

common serious complication at a rate of 10 The introduction

of osmotic laminaria tents dramatically decreased the incidence of

cervical laceration requiring repair for procedures between 20-26

weeks from 10 to 1 (Peterson 1983) and may decrease the risk

of uterine perforation as well

Despite the fact that the advent of osmotic dilation has improved

the safety of the DampE procedure during the second-trimester it

is unclear whether a certain type of osmotic dilator is superior to

another or whether osmotic dilation with adjuvant prostaglandin



is superior to osmotic dilation alone or to prostaglandins alone

This review examines all randomized controlled trials that com-

pare methods of cervical preparation for second-trimester surgical

abortion (such as osmotic dilators osmotic dilators with adjuvant

prostaglandin prostaglandin alone Foley catheters antiprogestins

and other methods that have been studied in this context)

O B J E C T I V E S

The objective of this review is to examine all randomized con-

trolled trials of cervical preparation methods for second-trimester

surgical abortion We compared the trials to each other with regard

to differences in procedure time dilation achieved (mm) need for

additional dilation complications ability to complete the proce-

dure patient pain scores and patient and provider acceptability

and satisfaction

M E T H O D S

Criteria for considering studies for this review

Types of studies

We included all randomized controlled trials in any language that

compare osmotic mechanical antiprogesterone prostaglandin or

other medical agents of cervical preparation for second-trimester

surgical abortion from 14-24 weeks of gestation

Types of participants

Data from all patients included in the eligible trials were incorpo-

rated into this review

Types of interventions

We included the following types of cervical preparation laminaria

DilapanT M Dilapan-ST M LamicelT M Foley catheter nitric ox-

ide antiprogesterones and prostaglandins We included studies

that evaluated same-day and multiple-day use of cervical prepara-

tion methods

Types of outcome measures

Primary Outcomes procedure time dilation achieved (mm) need

for additional dilation ability to perform procedure adverse events

secondary to dilators and complications (including but not lim-

ited to hemorrhage requiring transfusion infection requiring hos-

pitalization or antibiotics uterine perforation laparotomy hys-

terectomy)

Secondary Outcomes patient acceptability andor satisfaction

patient pain score provider acceptability andor satisfaction

provider assessment of difficulty of procedure

Search methods for identification of studies

We searched Medline using the following strategy

second trimester OR midtrimester OR mid-trimester OR preg-

nancy trimesters[mhnoexp] OR abortion OR (uterine OR uterus

OR vacuum AND aspiration[tiab]) OR (pregnancy OR abor-

tion AND (termination OR evacuat OR (dilat AND (curet-

tage OR extraction)))) AND (hygroscopic OR dilapan OR lam-

icel OR (magnesium sulfate AND polyvinyl alcohol) OR hypan

OR gemeprost OR prostaglandin OR laminaria OR polyvinyls

OR misoprostol OR meteneprost OR dinoprostone OR dino-

prost OR hydrophilic polymer OR sulprostone OR mifepristone

OR (osmotic OR cervical OR cervix OR intracervical OR in-

tra-cervical AND (dilat OR preparation OR priming OR mat-

uration OR ripening)) OR abortifacient agents[majr] OR abor-

tifacient[ti] OR foley OR balloon catheter OR nitric oxide)

OR (pregnancy trimester second OR pregnancy trimesters[mh

noexp] AND (abortion inducedmethods)) AND (randomized

controlled trial OR randomized controlled trials OR radnomized

OR clinical trial OR clinical trials OR ldquocontrolled studyrdquo OR

ldquocontrolled studiesrdquo OR controlled clinical trial OR random

allocation[mh] OR double-blind method[mh] OR single-blind

method[mh] OR research design[mhnoexp]) NOT (labor[ti] OR

labour[ti])

We searched EMBASE using the following strategy

rsquosecond trimesterrsquo OR rsquopregnancy terminationrsquo OR abortionOR

(uterine OR uterus AND aspiration) OR rsquovacuum aspirationrsquo

OR (pregnancy AND (termination OR evacuation OR (dilat

AND (curettage OR extract)))) AND (hygroscopic OR rsquodila-

panrsquoexp OR dilapan OR rsquolamicelrsquoexp OR lamicel OR (rsquomag-

nesium sulfatersquoexp OR rsquomagnesium sulfatersquo AND (rsquopolyvinyl al-

coholrsquoexp OR rsquopolyvinyl alcoholrsquo)) OR hypan OR rsquogemeprostrsquo

exp OR gemeprost OR rsquoprostaglandinrsquoexp OR prostaglandin

OR rsquoprostaglandinsrsquoexp OR prostaglandins OR rsquolaminariarsquoexp

OR laminaria OR rsquopolyvinyl alcohol spongersquoexp OR rsquopolyvinyl

alcohol spongersquo OR rsquopolyvinyl alcohol spongesrsquo OR rsquomisopros-

tolrsquoexp OR misoprostol OR rsquometeneprostrsquoexp OR meteneprost

OR rsquodinoprostonersquoexp OR dinoprostone OR rsquodinoprostrsquoexp OR

dinoprost OR rsquohydrophilic polymerrsquoexp OR rsquohydrophilic poly-

merrsquo OR rsquohydrophilic polymersrsquo OR rsquosulprostonersquoexp OR sulpro-

stone OR rsquomifepristonersquoexp OR mifepristone OR (osmotic OR

cervical OR rsquocervixrsquoexp OR cervix OR intracervical OR rsquointra-cer-

vicalrsquo AND (dilat OR preparation OR priming OR rsquomaturationrsquo

exp OR maturation OR ripening)) OR rsquofoley near5 catheterrsquoOR

rsquofoley near5 cathetersrsquo OR rsquofoley near5 balloonrsquo OR rsquofoley near5

balloonsrsquo OR rsquofoley near5 bulbrsquo OR rsquofoley near5 bulbsrsquoOR rsquobal-

loon catheterrsquoexp OR rsquoballoon catheterrsquo OR rsquonitric oxidersquoexp OR

rsquonitric oxidersquo OR rsquoabortive agentrsquoexp OR rsquouterine cervix ripen-



ingrsquo OR rsquouterine cervix dilatationrsquo) OR (rsquosecond trimesterrsquo OR

midtrimester OR rsquomid-trimesterrsquo AND (rsquoinduced abortionrsquo OR

(abortion AND induction) OR rsquosurgical abortionrsquo)) AND (rsquoran-

domized controlled trialrsquo OR rsquorandomized controlled trialsrsquo OR

radnomized OR rsquoclinical trialrsquo OR rsquoclinical trialsrsquoOR rsquocontrolled

studyrsquo OR rsquocontrolled studiesrsquo OR rsquocontrolled clinical trialrsquo OR

rsquocontrolled clinical trialsrsquo OR rsquodouble blind procedurersquo OR rsquosingle

blind procedurersquo) NOT (laborti OR labourti)

We searched POPLINE using the following two strategies

Strategy 1

(hygroscopic dilapan lamicel (magnesium sulfate amp polyvinyl

alcohol) hypan gemeprost prostaglandin laminaria

polyvinyl polyvinyls misoprostol meteneprost dinoprostone

dinoprost hydrophilic polymer sulprostone mifepristone

((osmotic cervical cervix intracervical intra-cervical) amp

(dilat preparation priming maturation ripening)) abor-

tifacient foley balloon catheter nitric oxide) amp (trimester

midtrimester mid-trimester abortion pregnancy fertility con-

trol postconception ((uterine uterus vacuum) amp aspiration)

(pregnancy amp (termination evacuat (dilat amp curettage)

(dilat amp extract)))) amp (randomized radnomized clinical trial

controlled study controlled studies =rdquostudiesrdquo)

Strategy 2

(second trimester midtrimester mid-trimester) amp (induced

abortion (induction amp abortion) surgical abortion) amp (random-

ized radnomized clinical trial controlled study controlled

studies =ldquostudiesrdquo)

We searched the Cochrane Database using the following strategy

(((midtrimester OR mid-trimester OR trimester OR abortion OR

pregnancy)tiabkw OR (uterine OR uterus OR vacuum) AND

aspirationtiabkw) AND (hygroscopic OR dilapan OR lamicel

OR (magnesium sulfate AND polyvinyl alcohol) OR hypan OR

gemeprost OR prostaglandin OR laminaria OR polyvinyls OR

misoprostol OR meteneprost OR dinoprostone OR dinoprost OR

hydrophilic polymer OR sulprostone OR mifepristone OR ((os-

motic OR cervical OR cervix OR intracervical OR intra-cervical)

AND (dilat OR preparation OR priming OR maturation OR

ripening)) OR abortifacient OR foley OR balloon catheter OR

nitric oxide)tiabkw OR ((midtrimester OR mid-trimester OR

second trimester)tiabkw AND (induced abortion OR (abortion

AND induction) OR surgical abortion)tiabkw)) NOT (labor

OR labour)ti

There were no date or language restrictions in our search We

searched the reference lists of identified studies relevant review

articles book chapters and conference proceedings for additional

previously unidentified trials We contacted experts in the field for

additional information on published and unpublished trials


Five thousand and five hundred and thirty-two titles and abstracts

were identified in the search and were assessed for inclusion The

methodological quality of the trials was assessed using the guide-

lines in the Cochrane reviewersrsquo handbook (Higgins 2009) Two

reviewers independently abstracted all data from the studies iden-

tified and attempts to retrieve missing data were made In order to

restrict the analysis to second-trimester procedures when possible

stratified study data within the 14-24 week gestation range was ob-

tained from the authors whose studies originally included data be-

yond this range No discrepancies existed with respect to inclusion

of studies or to abstracted data Data were entered into RevMan

50 and verified by a third reviewer RevMan 50 was used to an-

alyze the data Data were combined when similar measurements

were collected data were analyzed separately when cervical prepa-

ration methods and outcomes differed We calculated the mean

difference (MD) with 95 confidence intervals for continuous

variables (such as procedure time complication occurrences or

satisfaction scales) Peto odds ratios with 95 confidence intervals

were calculated to examine dichotomous variables (such as need

for additional dilation or ability to perform the procedure) When

additional information such as supplementary data or clarifica-

tions regarding study procedures was needed the authors were

contacted by email and information was successfully obtained

R E S U L T S

Description of studies

See Characteristics of included studies Characteristics of excluded

studies


studies

Six randomized controlled trials (Carbonell 2007 Edelman 2006

Goldberg 2005 Grimes 1987 Stubblefield 1984 and Zamblera

1994) met our inclusion criteria Together these studies accounted

for 1451 participants with sample sizes ranging from 50 to 900

One study (Edelman 2006) closed enrolment after enrolling 138

of the 144 planned participants due to longer than anticipated

enrolment with an interim analysis that demonstrated adequate

power The largest study (Carbonell 2007) compared four groups

of participants randomized to vaginal or sublingual misopros-

tol with or without oral mifepristone 48 hours prior Four of

the studies compared osmotic dilators to either prostaglandins

alone osmotic dilators with prostaglandins or to LamicelT M

(Edelman 2006 Goldberg 2005 Grimes 1987 Zamblera 1994)

One study compared one- versus two-day procedures with lam-

inaria (Stubblefield 1984) One study was conducted in Spain

(Carbonell 2007) and one in Britain (Zamblera 1994) The other

four studies were conducted in the United States (Edelman 2006

Goldberg 2005 Grimes 1987 Stubblefield 1984) in Oregon Cal-

ifornia Georgia and Massachusetts respectively



Our inclusion criteria required all studies to meet requirements

for randomization and to have enrolled participants whose gesta-

tional age at time of termination fell between 14-24 weeks as con-

firmed by ultrasound Three studies stated gestational age was their

only inclusion criteria (Grimes 1987 Stubblefield 1984 Zamblera

1994) two other studies also mentioned including only women

gt18 years old (Edelman 2006 Goldberg 2005) and one study re-

quired women to abstain from intercourse for 14 days post-proce-

dure for inclusion (Carbonell 2007) Three studies did not list ex-

clusion criteria (Grimes 1987 Stubblefield 1984 Zamblera 1994)

one study excluded participants only based on contraindications

to misoprostol or to anesthesia (Edelman 2006) and the remaining

two excluded patients on the basis of medical contraindications

such as anemia elevated blood pressure or infections (Carbonell

2007 Goldberg 2005) One study also excluded women based on

a number of other considerations more than one prior cesarean

delivery multiple gestation fetal demise myoma gt3cm history

of prior cervical procedure (cone biopsy or loop electrosurgical

excision procedure) bleeding disorder or on anticoagulation ther-

apy current IUD and currently breastfeeding with refusal to tem-

porarily discard milk (Goldberg 2005)

The cervical preparation methods used among the studies var-

ied None of the studies compared the same methods One study

evaluated mifepristone administration prior to vaginal or sub-lin-

gual misoprostol (Carbonell 2007) one compared laminaria with

misoprostol (Goldberg 2005) one compared DilapanT M to geme-

prost (Zamblera 1994) one compared laminaria with or with-

out the addition of misoprostol (Edelman 2006) one compared

LamicelT M to laminaria (Grimes 1987) and one compared sin-

gle- to two-day laminaria placement (Stubblefield 1984) Only

one study used mifepristone at a dose of 200mg (Carbonell 2007)

The three studies where misoprostol was used differed in their

dose route and timing with one study administering 600mcg

sublingually or vaginally 15-25 hours before the procedure after

having received 200mg mifepristone 48 hours prior (Carbonell

2007) and the other two using a dose of 400mcg either buccally

with laminaria 90 minutes before DampE (Edelman 2006) or vagi-

nally 3-4 hours before the procedure without additional cervical

preparation (Goldberg 2005) Of the four studies where laminaria

were used the majority used overnight application with various

numbers of laminaria one study placed one to two (size LL Nip-

pon) laminaria depending on gestational age (Edelman 2006) one

placed 3-6 medium laminaria (Goldberg 2005) and the study of

one- versus two-day preparation placed 3-7 small or medium tents

with half undergoing procedures the following morning and the

remaining half receiving another set of 7-19 tents to return on

the second day for the procedure (Stubblefield 1984) Only one

study conducted same-day procedures with laminaria compared

to LamicelT M placed a minimum of two hours before procedures

In this study medium laminaria were placed until snug and then

small laminaria until tightly packed (Grimes 1987) Similarly only

one study reviewed the two prostaglandin agents DilapanT M and

gemeprost (Zamblera 1994) and used the old formula of DilapanT M No included studies reviewed the newer Dilapan-ST M for-

mula released in 2002 Additionally gemeprost is rarely used as

the prostaglandin of choice because it has been replaced by miso-

prostol

Outcomes among the studies were heterogeneous The primary

outcome in most studies was degree of cervical dilation (Carbonell

2007 Edelman 2006 Grimes 1987 Stubblefield 1984 Zamblera

1994) while one study looked at procedure time as their primary

outcome (Goldberg 2005) Degree of cervical dilation in all cases

was measured by largest dilator passed into the cervical os with-

out resistance Of those where the primary outcome was cervical

dilation three studies also reviewed procedure time (Carbonell

2007 Edelman 2006 Stubblefield 1984) and in the study where

procedure time was the primary outcome (Goldberg 2005) cer-

vical dilation was also evaluated Only one study evaluated di-

lation prior to cervical preparation and again at a 2-week post-

procedure appointment (Stubblefield 1984) All studies reviewed

side effects of the preparation method and recorded complica-

tions (Carbonell 2007 Edelman 2006 Goldberg 2005 Grimes

1987 Stubblefield 1984 Zamblera 1994) with additional out-

comes evaluating subjective physician rated difficulty of the di-

lation (Edelman 2006 Goldberg 2005 Zamblera 1994) overall

difficulty of the procedure (Goldberg 2005) total estimated blood

loss (Edelman 2006 Goldberg 2005 Stubblefield 1984) subject

acceptability of the method (Goldberg 2005) and cost (Grimes

1987) Where side effects were reviewed all included pain nausea

or emesis diarrhea and bleeding Immediate complications were

reported and compared in all included studies Two studies had

patient follow up after the abortion (Stubblefield 1984 Zamblera

1994) One study followed up by providing participants access to

a 24-hour hotline a take-home questionnaire to return via mail a

two-week clinic follow-up visit and a questionnaire mailed three

months later (Stubblefield 1984) and the other contacted patients

6 weeks post-procedure but did not specify their contact method

(Zamblera 1994)

Risk of bias in included studies

Randomization method

Three studies used computer-generated randomization methods

(Carbonell 2007 Edelman 2006 Goldberg 2005) two used ran-

dom number tables (Grimes 1987 Stubblefield 1984) and one

drew a random card from an envelope for each subject placement

(Zamblera 1994)

Allocation

Four studies utilized adequate allocation concealment (Carbonell

2007 Edelman 2006 Goldberg 2005 Grimes 1987) with all

studies utilizing sequentially-numbered opaque sealed envelopes



The remaining two studies did not specify their allocation con-

cealment methods (Stubblefield 1984 Zamblera 1994)

Loss to follow-up

All studies reported low rates of loss to follow-up One study

comparing misoprostol alone to mifepristone plus misoprostol re-

ported that there were nine dropouts (9450) post-randomization

in the mifepristone plus misoprostol group including two patients

who had at-home expulsions (Carbonell 2007) The remaining

seven mifepristone plus misoprostol patients did not return the

following day for the DampE procedure In the misoprostol-only

group there were 14 dropouts (14450) after randomization Out-

comes on these patients are unknown One study reported that

four women chose not to proceed with the procedure but did

not state specifically that the patients failed to return for their

procedures only that they were excluded (Edelman 2006) An-

other study reported that only one patient failed to return for the

procedure after randomization to misoprostol (Goldberg 2005)

Two other studies reported no loss to follow-up (Grimes 1987

Zamblera 1994)

Sample Size Calculations

Sample size calculations were specified for four studies (Carbonell

2007 Edelman 2006 Goldberg 2005 Grimes 1987) two stud-

ies did not specify sample size calculations (Stubblefield 1984

Zamblera 1994)

Blinding

Three of the studies were double-blinded with both patient and

physicians performing the procedure unaware of the study group

(Edelman 2006 Goldberg 2005 Grimes 1987) one study was

single-blinded with the physicians being unaware of treatment

arm (Zamblera 1994) and two studies reported not blinding (

Carbonell 2007 Stubblefield 1984)

Effects of interventions

The studies could not be combined into a meta-analysis given

the heterogeneity of the cervical preparation methods compared

When the studies were combined into studies comparing osmotic

dilators to prostaglandin preparations only two studies met this

criteria (Goldberg 2005 Zamblera 1994) One study did not state

standard deviation but instead stated range making comparisons

of these two studies using mean difference in procedure time not

possible (Zamblera 1994) The main objective outcomes addressed

are cervical dilation procedure time side effects and complica-

tions While side effects may be an indicator of patient satisfaction

only one study specifically asked patients about patient experience

(Goldberg 2005) Other subjective outcomes reviewed were esti-

mated blood loss and physician difficulty Where estimated blood

loss was addressed there were no differences seen While some

studies reviewed subjective physician-rated difficulty we felt that

procedure time is generally an indication of physician difficulty

and thus included this measure when available in our analysis

Cervical Dilation

In the five studies comparing cervical dilation it was measured

by recording the dilator circumference where no resistance was

felt after starting dilation with the largest dilator and decreas-

ing in circumference until one would easily pass through the in-

ternal cervical os (Edelman 2006 Goldberg 2005 Grimes 1987

Stubblefield 1984 Zamblera 1994) One study measured initial

dilation in the reverse method by recording the diameter of the

Hegar dilator inserted into the cervix just before cervical resis-

tance was first noticed (Carbonell 2007) In one study (Goldberg

2005) 400mcg vaginal misoprostol placed 3-4 hours before the

procedure was compared to the placement of 3-6 medium lami-

naria overnight Laminaria demonstrated significantly greater di-

lation than misoprostol alone (MD 330 95 CI 222 to 438)

This was also true of the study comparing DilapanT M and geme-

prost (Zamblera 1994) where DilapanT M was found to dilate the

cervix significantly more than gemeprost (MD 580 95CI 303

to 857) When combined these two studies showed that osmotic

dilators resulted in a significantly greater initial cervical dilation

measurement than when a prostaglandin was used alone (WMD

363 95 CI 262 to 463) (Figure 1) and significantly easier di-

lation (WMD 017 95CI 006 047) Figure 2

Figure 1 Forest plot of comparison 1 Osmotic Dilators vs Prostaglandins outcome 11 Initial Dilation

(mm)



Figure 2 Forest plot of comparison 1 Osmotic Dilators vs Prostaglandins outcome 12 Difficult Dilation

The addition of misoprostol to overnight laminaria was not found

to improve initial cervical dilation (Edelman 2006 Figure 3)

When grouped together a benefit from adding misoprostol to

laminaria was not seen in initial cervical dilation for procedures

between 13-21 weeks (MD 150 95 CI -063 to 363) (Edelman

2006) However when stratified by gestational age a significant

improvement in initial dilation was reported when misoprostol

was added to laminaria in gestations greater than 19 weeks These

data are not shown since the study was not powered to detect such

a difference

Figure 3 Forest plot of comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) outcome 42

Initial Dilation (mm)

One study found that two days of cervical preparation with a new

set of twice as many laminaria on the second day resulted in signif-

icantly more cervical dilation than one day of cervical preparation

with one set of laminaria tents (MD 420 95 CI 281 to 559)

(Stubblefield 1984 Figure 4) A more recent study compared four

groups of patients receiving 600mcg of either vaginal or sublin-

gual misoprostol with or without the administration of 200mg

mifepristone 48 hours before procedures and found the addition

of mifepristone to misoprostol significantly increased initial cer-

vical dilation (MD 500 95 CI 460 to 540) (Carbonell 2007

Figure 5)



Figure 4 Forest plot of comparison 7 One- vs Two-Day Laminaria Placement (17-19 weeks) outcome 72


Figure 5 Forest plot of comparison 5 Misoprostol (vaginal or sub-lingual) Alone vs Misoprostol (vaginal or

sub-lingual) and Mifepristone (14-20 weeks) outcome 51 Initial Dilation (mm)

One study (Goldberg 2005) found that cervices prepared with

laminaria required additional dilation less frequently than those

prepared with misoprostol alone (OR 007 95 CI 003 to 017)

(Figure 6) When misoprostol was added to laminaria (Edelman

2006) Figure 16) a trend toward less need for additional dilation

(Figure 7 and less difficult additional dilation (Figure 8) was seen

among women who had received both laminaria and misopros-

tol however these differences did not reach statistical significance

One study used DilapanT M dilators as an additional cervical di-

lation method when deemed necessary and found that misopros-

tol with mifepristone resulted in more need for additional dila-

tion with DilapanT M than misoprostol alone regardless of the

route of misoprostol administration (OR 162 95 CI 120 to

) (Carbonell 2007 Figure 9) In this study participants received

a bimanual exam 48 hours after mifepristone administration Di-

lapanT M dilators were placed at this time if it was felt by the ex-

aminer that ldquoadequate cervical conditions for surgery were not

achievedrdquo It is unclear as to when the bimanual exam and decision

to place DilapanT M dilators was made for the subjects who re-

ceived misoprostol only This surprising difference in greater need

for additional dilation among the combination group may be due

to lack of blinding andor slightly different study protocols with

respect to pre-operative DilapanT M placement for those patients

randomized to mifepristone plus misoprostol vs those random-

ized to misoprostol only This unexpected difference is thought

by the authors to be due to the fact that the mean gestational age

in the combination group was greater than that in the misoprostol

alone group (167 +- 18 vs 151 +- 15 weeks plt0001 re-

spectively) and dilation was expected to be more difficult among

those with higher gestational age (Carbonell 2007) One study

compared laminaria to LamicelT M and did not evaluate absolute

dilation but rather had a dichotomous outcome of whether ad-

ditional dilation was required or not based on having an initial

cervical dilation measurement of less than 37 French units (Figure

10) In this study they found that LamicelT M more often required

additional dilation compared to laminaria (OR 042 95 CI 020

to 086) (Grimes 1987 Figure 11)



Figure 6 Forest plot of comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) outcome 22 Need for

Additional dilation


Need for Additional Dilation ( yes)


Difficult Dilation ( yes)


sub-lingual) and Mifepristone (14-20 weeks) outcome 52 Need for Additional Dilation



Figure 10 Forest plot of comparison 6 Laminaria vs Lamicel (14-16 weeks) outcome 62 Adequate Initial

Dilation (gt or = 37 French units)

Figure 11 Forest plot of comparison 6 Laminaria vs Lamicel (14-16 weeks) outcome 61 Need for dilation

beyond 37 French units

Procedure Time

Four studies compared procedure time (Carbonell 2007 Edelman

2006 Goldberg 2005 Stubblefield 1984) When comparing

overnight laminaria to same-day misoprostol laminaria was found

to have a significantly shorter mean procedure time of 502 (SD=

406) compared to 733 minutes (SD=431) (MD -231 95CI

-429 to -033) (Goldberg 2005 Figure 12) When laminaria was

combined with misoprostol and compared to laminaria alone no

difference was noted in mean procedure time regardless of gesta-

tional age range (MD -005 95 CI -101 to 091) (Edelman

2006 Figure 13) The addition of mifepristone to misoprostol

had a significant effect on increasing mean procedure time from

122 (SD=45) to 142 minutes (SD=63) (MD 200 95 CI 116

to 284) regardless of the route of misoprostol (Carbonell 2007

Figure 14) As was the case with need for additional dilation this

unexpected difference in procedure time is thought by the authors

to be due to the fact that the mean gestational age in the combi-

nation group was greater than that in the misoprostol alone group

(167 +- 18 vs 151 +- 15 weeks plt0001 respectively) and

thus the procedure time in the combination group was also greater

When one-day procedures were compared to two-day procedures

no difference in mean procedure times was found (MD -030

95 CI -193 to 133) (Stubblefield 1984 Figure 15)

Figure 12 Forest plot of comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) outcome 21

Procedure TIme




Procedure Time


sub-lingual) and Mifepristone (14-20 weeks) outcome 53 Procedure time (min)


Procedure Time (min)

Side Effects

All six studies recorded side effects with three studies comparing

multiple side effects (Carbonell 2007 Edelman 2006 Goldberg

2005) More gastrointestinal side effects were experienced among

women who had received misoprostol with mifepristone compared

to women who received misoprostol alone (OR 303 95 CI 204

to 452) (Figure 16) while feverschills (OR 113 95 CI 087

to 147) and pre-procedure vaginal bleeding did not significantly

differ (OR 098 95 CI 048 to 200) (Figure 17) between the

groups (Carbonell 2007) Although no difference in bleeding was

seen in this study as a result of the cervical priming agent alone

twenty unintended pre-procedural abortions occurred in this study

(Figure 18) Two abortions occurred following the administration

of mifepristone only 15 following mifepristone and misoprostol

and three after misoprostol only When comparing overnight lam-

inaria to misoprostol alone no differences were found between the

two groups with respect to experiencing nausea (Figure 19) vom-

iting (Figure 20) diarrhea (Figure 21) fever (Figure 22) or chills

(Figure 23) at any time during the study period (Goldberg 2005)

When comparing laminaria alone to laminaria plus misoprostol

gastrointestinal symptoms (nausea vomiting and diarrhea) were

found to be rare among women in both groups however women in

the laminaria-only group experienced significantly less pre-proce-

dure cramping (OR 025 95 CI 012 to 053) (Edelman 2006)

(Figure 24)




sub-lingual) and Mifepristone (14-20 weeks) outcome 54 GI effects (nausea vomiting diarrhea)


sub-lingual) and Mifepristone (14-20 weeks) outcome 55 Spotting


sub-lingual) and Mifepristone (14-20 weeks) outcome 56 Pre-procedural Expulsion Abortion

Figure 19 Forest plot of comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) outcome 23 Nausea



Figure 20 Forest plot of comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) outcome 24 Vomiting

Figure 21 Forest plot of comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) outcome 25 Diarrhea

Figure 22 Forest plot of comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) outcome 26 Fevers

Figure 23 Forest plot of comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) outcome 27 Chills




Cramps after cervical preparation

One study reported differences in preoperative vaginal spotting

(Figure 25) and pain (Figure 26) between patients who received

DilapanT M and those who received gemeprost (Zamblera 1994)

Significantly fewer women reported pre-operative bleeding and

pre-operative pain in the DilapanT M group (OR 012 95 CI

002 090 and OR 013 95 CI 003 048 respectively) An-

other study reported one-fifth the number of vasovagal reactions

during LamicelT M insertion compared to laminaria but the abso-

lute number was low This difference was not significant and no

other side effects were reported (Grimes 1987)

Figure 25 Forest plot of comparison 3 Hypan vs Gemeprost (15-20 weeks) outcome 31 Spotting

Figure 26 Forest plot of comparison 3 Hypan vs Gemeprost (15-20 weeks) outcome 32 Pain

Complications

All six studies recorded immediate complications and the overall

complication rates were low None of the studies found signifi-

cant differences between study groups with respect to complica-

tions One reported a complication rate of 13 with 9 immediate

procedural complications including four cervical tears (one in the

mifepristone with misoprostol group and three in the misoprostol



alone group) and five hospitalizations (three due to hemorrhage

with two patients receiving transfusions one due to thrombocy-

topenia and HIV and one due to a decrease in fibrinogen) out

of 692 patients (Carbonell 2007) Other than one patient with

hemorrhage after mifepristone administration the authors did not

state to which treatment arm the two remaining patients who ex-

perienced post-abortal hemorrhage belonged In this same study

20 pre-procedural abortions that occurred 17 in the combination

group and three in the misoprostol alone arm These unscheduled

abortions were not considered to be complications however the

difference in frequency of pre-procedure expulsions between the

two groups is significant (OR 547 95 CI 224 to 1340) (Figure

18)

Goldberg noted five immediate complications with three in the

misoprostol group (one perforation and two cervical lacerations)

and two in the laminaria group (one endometritis and one patient

with retained products of conception) (Goldberg 2005) Grimes

reported no immediate complications in the laminaria group but

three cervical lacerations in the LamicelT M group (Grimes 1987)

Stubblefied reported one patient with retained products of con-

ception in the one-day laminaria group and reported no lacer-

ations or perforations in either the one or two day laminaria

groups (Stubblefield 1984) Edelman (Edelman 2006) and Zam-

blera (Zamblera 1994) reported no immediate complications

Only two studies contacted patients after their procedure (

Stubblefield 1984 Zamblera 1994) Zamblera followed-up with

patients six weeks later and noted one complication in each group

including one patient with retained products of conception in the

gemeprost group and one patient with a urinary tract infection

in the DilapanT M group (Zamblera 1994) Stubblefield followed-

up with patients at multiple time-points up to 28 days later and

found three additional delayed complications two in the one-day

and one in the two-day laminaria group (Stubblefield 1984) One

patient in the two-day procedure group reported post-operative

fever at 24 hours another patient in the one-day procedure group

reported post-operative bleeding three weeks post-procedure and

one patient in the one-day procedure group presented with vagini-

tis and bleeding 28 days later

D I S C U S S I O N

Given the heterogeneity of the studies reviewed combining out-

comes among most studies was not possible All included studies

used some method of cervical preparation before second-trimester

surgical abortion which is currently standard among abortion

providers (Fox 2007 Newmann 2008) We found only one study

that compared placebo to a prostaglandin for cervical preparation

before second-trimester surgical abortion (Van Den Bergh 1976)

Though it was one of the first studies to suggest benefit of us-

ing prostaglandins for cervical preparation before second-trimester

surgical abortion it did not meet inclusion criteria for our review

The amount of cervical dilation prior to a procedure is expected

to correlate with the difficulty of the procedure for the physician

and therefore complications encountered In this review some de-

ductions can be made pertaining to the best methods for cervical

preparation based on the randomized controlled trials included

Two studies suggest that osmotic dilation is superior to the use

of a prostaglandin alone Goldberg (Goldberg 2005) found that

both cervical dilation and procedure time were improved by us-

ing laminaria rather than misoprostol and that more patients re-

quired additional dilation when only misoprostol was used And

Zamblera (Zamblera 1994) found that DilapanT M was superior to

gemeprost for dilation The addition of misoprostol to laminaria

seems nominal as evidenced by Edelman (Edelman 2006) who

found no significant improvement in initial dilation or procedure

time when misoprostol was added to overnight laminaria Not sur-

prisingly significantly greater dilation was found when two-day

cervical ripening with laminaria was performed however this did

not effect the procedure time and added an additional burden to

patients and staff resources (Stubblefield 1984)

When administered 48 hours before misoprostol mifepristone

was found to significantly increase dilation yet also increase need

for pre-operative dilation with DilapanT M dilators and increase

procedure time (Carbonell 2007) This unexpected increase in

procedure time and need for additional dilation is thought to be

due to the greater mean gestational duration of the patients in

the combination arm Additionally physicians were not blinded

to the treatment methods in this study which could have led to

possible bias in the placement of DilapanT M dilators pre-oper-

atively and in results The route of misoprostol administration

(sublingual or vaginal) did not appear to influence any of these

outcomes However mifepristone administration 48 hours before

misoprostol resulted in significantly more expulsion abortions be-

fore the procedure which could be an immense psychological and

physical burden to a patient who has chosen surgical abortion

LamicelT M was not found to differ from laminaria with respect to

preoperative cervical dilation (Grimes 1987)

Side effects were not routinely found to be greater when miso-

prostol was compared to osmotic dilators The addition of miso-

prostol when compared to laminaria alone caused more pre-pro-

cedure cramping but did not influence rates of gastrointestinal

symptoms (Edelman 2006) When added to misoprostol mifepri-

stone appeared to increase the frequency of gastrointestinal side

effects (Carbonell 2007) When DilapanT M and gemeprost were

compared more patients had pain with the prostaglandin than

with the osmotic dilator (Zamblera 1994) Laminaria and LamicelT M did not differ with respect to side effects (Grimes 1987) Ei-

ther method appears appropriate for same-day cervical preparation

prior to early second-trimester abortion procedures (14-16 weeks)

No randomized controlled trials have evaluated other same-day

cervical dilation comparisons however there are retrospective data



to show that same-day use of misoprostol up to 18 weeks gestation

is safe and effective (Todd 2002 Castleman 2006)

As mentioned above mifepristone plus misoprostol resulted in

significantly more pre-procedure expulsion abortions (Carbonell

2007) an experience that has the potential for psychological bur-

den in addition to increased rates of complications such as hemor-

rhage and infection if expulsions occur outside of a medical setting

without access to uterotonic medications and surgical evacuation

The impact of the increased rate of pre-procedural abortions on

patient satisfaction and experience was not addressed in this study

While mifepristone and misoprostol have been used for second-

trimester medical abortion this is the first study to evaluate the

combination as cervical preparation before second-trimester DampE

procedures Given the high rate of pre-procedure abortions in this

study the utility of further investigation of this combined regimen

for cervical preparation prior to second trimester DampE appears to

be limited

The generalizability of our findings is limited by the heterogene-

ity of the cervical preparation methods used outcomes evaluated

and lack of data for gestations beyond 21 weeks Out of 1215 par-

ticipants included in the review only 125 participants included

women between 20-20 67 weeks gestation The majority of the

participants (927) included women at 18 weeks gestation or be-

yond thus our findings are really most applicable to patients in the

early or mid second-trimester but not beyond 21 weeks gestation

Regardless of cervical preparation method used immediate com-

plications were few The most common complication regardless

of the method of preparation was cervical laceration repaired at

the time of the procedure

A U T H O R S rsquo C O N C L U S I O N SImplications for practice

Our review supports the current practice of using osmotic dilators

for cervical preparation before second-trimester abortion proce-

dures by DampE

bull Cervical dilation with osmotic dilators is superior to

cervical dilation with a prostaglandin alone or with laminaria

plus a prostaglandin prior to early second-trimester DampE

However superior cervical dilation does not appear to correlate

consistently with procedure time or complication rates between

14-21 weeks gestation

bull No data found to suggest differences in procedure-related

complications or in the ability to complete the procedure among

the different regimen combinations

bull Data did not suggest a benefit to two-day procedures versus

one-day procedures in the early second trimester (below 19

weeks gestational duration)

bull Same-day procedures using misoprostol for cervical

preparation appear to be a safe and reasonable option in the

early second trimester

Implications for research

Future studies are needed to expand upon and confirm the findings

described in these studies such as

bull the effectiveness of same-day cervical preparation for

second-trimester procedures

bull the utility of adding misoprostol to laminaria for cervical

preparation in advanced gestations

bull the role of mifepristone in combination with osmotic

dilators for cervical preparation for second-trimester DampE and

bull the number of osmotic dilators needed for cervical

preparation at different gestational age

A C K N O W L E D G E M E N T S

Gloria Won for her tireless assistance in designing and executing

the search strategies



R E F E R E N C E S

References to studies included in this review

Carbonell 2007 published and unpublished datalowast Carbonell JL Gallego FG Llorente MP Bermudez SB Sala ES

Gonzalez LV Texido CS Vaginal vs sublingual misoprostol with

mifepristone for cervical priming in second-trimester abortion by

dilation and evacuation A randomized clinical trial Contraception

200775(3)230ndash7

Edelman 2006 published and unpublished datalowast Edelman AB Buckmaster JG Goetsch MF Nichols MD Jensen

JT Cervical preparation using laminaria with adjunctive buccal

misoprostol before second-trimester dilation and evacuation

procedures a randomized clinical trial American Journal of

Obstetrics and Gynecology 2006194(2)425ndash30

Goldberg 2005 published and unpublished datalowast Goldberg AB Drey EA Whitaker AK Kang MS Meckstroth

KR Darney PD Misoprostol compared with laminaria before early

second-trimester surgical abortion a randomized trial Obstetrics

Gynecology 2005106(2)234ndash41

Grimes 1987 published and unpublished datalowast Grimes DA Ray IG Middleton CJ Lamicel versus laminaria for

cervical dilation before early second-trimester abortion a

randomized clinical trial Obstetrics and Gynecology 198769(6)

887ndash90

Stubblefield 1984 published and unpublished datalowast Stubblefield PG Altman AM Goldstein SP Laminaria treatment

prior to late mid-trimester abortion by uterine evacuation In

Hafez ES editor(s) Voluntary Termination of Pregnancy Lancaster

England MTP Press 198475ndash82

Zamblera 1994 published and unpublished datalowast Zamblera D Thilaganathan B Parsons J Randomised trial of

hypan versus gemeprost in cervical preparation prior to second

trimester termination of pregnancy British Journal of Obstetrics and

Gynaecology 1994101(6)543ndash4

References to studies excluded from this review

Golland 1989 published data onlylowast Golland IM Vaughan-Williams CA Elstein M A comparison of

osmotic dilators lamicel and dilapan and a prostaglandin E1

analogue gemeprost for ripening the cervix before legal abortion

Journal of Obstetrics and Gynaecology 19899(3)210ndash2

Hackett 1989 published data onlylowast Hackett GA Reginald P Paintin DB Comparison of the foley

catheter and dinoprostone pessary for cervical preparation before

second trimester abortion British Journal of Obstetrics and


Hern 1994 published data onlylowast Hern WH Laminaria versus dilapan osmotic cervical dilators for

outpatient dilation and evacuation abortion Randomized cohort

comparison of 1001 patients American Journal of Obstetrics and


Killick 1985 published data onlylowast Killick SR Vaughan-Williams CA Elstein M A comparison of

prostaglandin E2 pessaries and laminaria tents for ripening the

cervix before termination of pregnancy British Journal of Obstetrics

and Gynaecology 198592(5)518ndash21

Kline 1995 published data onlylowast Kline SB Meng H Musick RA Cervical dilation from laminaria

tents and synthetic osmotic dilators used for 6 hours before

abortion Obstetrics and Gynecology 199586(6)931ndash35

Lauersen 1982 published data onlylowast Lauersen NH Den T Iliescu C Wilson KH Graves ZR Cervical

priming prior to dilatation and evacuation A comparison of

methods American Journal of Obstetrics and Gynecology 1982144

(8)890ndash894

Wells 1989 published data onlylowast Wells EC Hulka JF Cervical dilation A comparison of lamicel

and dilapan American Journal of Obstetrics and Gynecology 1989

161(5)1124ndash1126

Additional references

Altman 1985

Altman AM Stubblefield PG Schlam JF Loberfeld R

Osathanondh R Midtrimester abortion with laminaria and vacuum

evacuation on a teaching service Journal of Reproductive Medicine

198530(8)601ndash6

Behrman 2007

Behrman RE Butler AS Preterm Birth Causes Consequences and

Prevention 1 National Academies Press 2007 [ ISBNndash13

978ndash0ndash309ndash10159ndash2]

Bierer 1972

Bierer I Steiner V Termination of pregnancy in the second

trimester with the aid of laminaria tents Medicine Gynaecology and

Sociology 19726(1)9ndash10

Castleman 2006

Castleman LD Oanh KT Hyman AG Thuy LT Blumenthal PD

Introduction of the dilation and evacuation procedure for second-

trimester abortion in Vietnam using manual vacuum aspiration and

buccal misoprostol Contraception 200674272ndash276

Chvapil 1982

Chvapil M Droegemueller W Meyer T Macsalka R Stoy V Suciu

T New synthetic laminaria Obstetrics and Gynecology 198260(6)

729ndash33

Darney 1986

Darney PD Preparation of the cervix Hydrophilic and

prostaglandin dilators Clinics in Obstetrics and Gynaecology 1986

13(1)43ndash51

Eaton 1972

Eaton CJ Cohn F Bollinger CC Laminaria tent as a cervical

dilator prior to aspiration-type therapeutic abortion Obstetrics and


FEMA 2003

Dilapan-S the hygroscopic cervical dilator package insert FEMA

International Kendall Park NJ 1998 Vol [updated 3rd April

2003] issue Accessed on 16th January 2008http

wwwdilapancompdf

DilapanndashS20insert20English20Internationalpdf



Finer 2005

Finer LB Henshaw SK Estimates of US abortion incidence in

2001 and 2002 Guttmacher Institute 2006 issue http

wwwguttmacherorgpubs20050518ab˙incidencepdf

Fox 2007

Fox M Hayes J Cervical preparation for second-trimester surgical

abortion prior to 20 weeks gestation Contraception 200776(6)

486ndash95

Grimes 1984

Grimes DA Schulz KF Cates WJ Prevention of uterine

perforation during currettage abortion Journal of the American

Medical Association 1984251(16)2108ndash11

Herczeg 1986

Herczeg J Sas M Szabo J Vajda G Pre-evacuation dilatation of the

pregnant uterine cervix by laminaria japonica Acta Medica

Hungarica 198643(2)145ndash54

Higgins 2009

Higgins JPT Green S editors Cochrane Handbook for Systematic

Reviews of Interventions 502 The Cochrane Collaboration

2009

Kalish 2002

Kalish RB Chasen ST Rosenzweig LB Rashbaum WK Chervenak

FA Impact of midtrimester dilation and evacuation on subsequent

pregnancy outcome American Journal of Obstetrics and Gynecology

2002187(4)882ndash5

Karim 1971

Karim SM Sharma SD Therapeutic abortion and induction of

labour by the intravaginal administration of prostaglandins E 2 and

F 2 Journal of Obstetrics Gynaecology of the British Commonwealth

197178(4)294ndash300

Krammer 1995

Krammer J OrsquoBrien WF Mechanical methods of cervical ripening

Clinical Obstetrics and Gynecology 199538(2)280ndash6

Lichtenberg 2004

Lichtenberg ES Complications of osmotic dilators Obstetrical and

Gynecological Survey 200459(7)528ndash36

Lohr 2008

Lohr PA Hayes JL Gemzell-Danielsson K Surgical versus medical

methods for second trimester induced abortion Cochrane Database

of Systematic Reviews 2008 Issue 1 [Art No CD006714 DOI

10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996

Munsick RA Fineberg NS Cervical dilation from multiple

laminaria tents used for abortion Obstetrics and Gynecology 1996

87(5 pt 1)726ndash9

Newmann 2008

Newmann S Dalve-Endres A Drey E Cervical preparation for

second-trimester surgical abortion from 20-24 weeksrsquo gestation

Contraception 200877(4)308ndash14

Newton 1972

Newton BW Laminaria tent Relic of the past or modern medical

device American Journal of Obstetrics and Gynecology 1972113(4)

442ndash8

Patel 2006

Patel A Talmont E Morfesis J Pelta M Gatter M Momtaz MR et

alAdequacy and safety of buccal misoprostol for cervical

preparation prior to termination of second-trimester pregnancy


Peterson 1983

Peterson WF Berry FN Grace MR Gulbranson CL Second-

trimester abortion by dilatation and evacuation An analysis of 11

747 cases Obstetrics and Gynecology 198362(2)185ndash90

Poon 2007

Poon LC Parsons J Audit of the effectiveness of cervical

preparation with dilapan prior to late second-trimester (20-24

weeks) surgical termination of pregnancy BJOG an international

journal of obstetrics and gynaecology 2007114(4)485ndash8

RCOG 2004

Royal College of Obstetricians and Gynaecologists The care of

women requesting induced abortion London RCOG Press 2004

Schulz 1983

Schulz KF Grimes DA Cates WJ Measures to prevent cervical

injury during suction curettage abortion Lancet 19831(8335)

1182ndash5

Stat Service 2005

Government Statistical Service Abortion Statistics England and

Wales Statistical Bulletin 2006 4 July 2006 Vol 01

Todd 2002

Todd CS Soler M Castleman L Rogers MK Blumenthal PD

Buccal misoprostol as cervical preparation for second trimester

pregnancy termination Contraception 200265(6)415ndash8

Van Den Bergh 1976

Van Den Bergh AS Szabo E Szontagh FE Preoperative cervical

dilatation by oral PGE2 Contraception 197614(6)631ndash7

WHO 1997

World Health Organization Medical methods for termination of

pregnancy Report of a WHO Scientific Group Technical Report

Series 1997871(i-vii)1ndash110

WHO 2003

World Health Organization Safe Abortion Technical and Policy

Guidance for Health Systems World Health Organization 2003

30

Wiquist 1970

Wiquist N Bydgeman M Therapeutic abortion by local

administration of prostaglandins Lancet 19702(7675)716ndash7lowast Indicates the major publication for the study



C H A R A C T E R I S T I C S O F S T U D I E S

Characteristics of included studies [ordered by study ID]

Carbonell 2007

Methods Randomized Clinical Trial

Computer-generated random list

Single center (Clinica Mediterrania Medica Valencia Spain)

Power CalculationSample Size Average cervical dilation expected to be 15mm more in the mifepristone

and misoprostol group power of 90 one-tail test with significance level of 005 min sample size

190subjects per group and increased 15 for losses Adjusted significance level to 010 when ANOVA

performed

Funding covered by Clinica Mediterrania Medica Valencia Spain

Study approved by the Scientific and Ethics Committee of the Clinic

Published as full paper

Participants Inclusion Women presenting for termination between 12-20 weeks via DampE Gestational age by ultra-

sound with BPD 20-46mm willing to abstain from intercourse for 14 days after procedure

Exclusion Hemoglobin lt90 Blood Pressure gt16090 uterine bleeding active genital infection intoler-

anceallergy to misoprostol or mifepristone

Number of women radnomized 900

Study dates July 9 2004 to February 9 2006

Interventions Four groups 200mg mifepristone administered or not administered 48 hours before administration of

600mcg sublingual or vaginal misoprostol Patients then waited 15-25 hours

When examined at misoprostol placement if felt ldquonot adequate cervical conditionsrdquo one or two Dilapan

tents were inserted intracervically

Outcomes Primary outcome Degree of cervical dilation reached prior to procedure measured by diameter of Hegar

dilator before cervical resistance first noticed

Secondary outcomes Surgical time from anesthesia administration to speculum removal

Other outcomes Side effects (nausea vomiting diarrhea feverchills) amount of external cervical orifice

dilation at inspection presence of bloodproducts of conception in external os andor vagina immediate

complications

Notes Warned patients of fetal risks once mifepristone administered

Risk of bias

Item Authorsrsquo judgement Description

Allocation concealment Yes Assignment by sequentially numbered sealed

opaque envelopes

Blinding

All outcomes

No Physician and patient aware of treatment group



Edelman 2006

Methods Randomized double-blind placebo-controlled trial

Computer-generated block randomization by gestational age group (earlymid)

Single center (Lovejoy Surgicenter in Portland Oregon USA)

Power CalculationSample Size Expected difference in cervical circumference of 4mm 80 power alpha

level of 005 72 subjects needed

Funding support by Lovejoy Surgicenter

Study protocols approved by the Institutional Review Board at Oregon Health and Sciencs University

Published as full study

Participants Inclusion Women seeking DampE termination between 13 to 20w6d confirmed by ultrasound age gt18

years old good general health English speaking

Exclusion Inability to receive deep conscious sedation contraindication to misoprostol pregnancies

beyond 20w6d excluded because they undergo a 2-day cervical preparation procedure

Number of women radnomized 138 (closed prior to planned 144 subjects due to longer-than-expected

enrolment period)

Study dates September 2002 to October 2004

Interventions Two groups 1-2 (size LL Nippon) laminaria overnight plus 400mcg buccal misoprostol or 500mg buccal

magnesium oxide (placebo) 60-90 minutes prior to DampE Laminaria placement based on gestational age

Early (13-15w6d) 1-Laminaria Mid (16-20w6d) 2-Laminaria an additional laminaria was placed when

needed to assist with successful retention of laminaria

Outcomes Primary Outcome Degree of cervical dilation reached prior to procedure measured by diameter of dilator

where loss of resistance first noted

Secondary Outcomes Difficulty of dilation on a 100mm Visual Analog Scale (VAS) (0=very easy to

100mm=very hard) need for additional dilation and if difficult (yesno) procedure time (from speculum

insertion to removal) estimated blood loss

Other outcomes Side effects (cramping nausea diarrhea bleeding) immediate complications

Notes Two experienced abortion providers performed procedures

Risk of bias


Allocation concealment Yes Assignment by sealed opaque envelopes

Blinding

All outcomes

Yes Double-blinded



Goldberg 2005


Block randomization from a computer-generated random numbers table

Single center (San Francisco General Hospital San Francisco California USA)

Power CalculationSample Size To detect a 45min difference between groups two-tailed hypothesis with

alpha error 005 and 95 power 78 subjects needed

Funding support from University of California San Francisco Center for Reproductive Health Research

and Policy

Study approved by Committee on Human Research of the University of California San Francisco


Participants Inclusion Women seeking abortion procedures between 12w6d and 15w6d verified by ultrasound En-

glishSpanish speaking good health gt18 years old

Exclusion More than one prior cesarean delivery multiple gestation fetal demise documented cervical

or lower uterine segment myoma (gt3cm) history of prior cone biopsy or loop electrosurgical excision

procedure bleeding disorder or anticoagulation therapy IUD in place allergy to misoprostol breastfeeding

and unwilling to temporarily discard milk

Number of women radnomized 84 (one patient in misoprostol group failed to appear on second day for

procedure)

Study dates February 2002 to September 2003

Interventions Two groups 400mcg vaginal misoprostol 3-4hours prior to procedure vs 3-6 medium laminaria overnight

Outcomes Primary Outcome Procedure time

Secondary Outcomes Degree of cervical dilation reached prior to procedure measured by diameter of Pratt

dilator where loss of resistance first noticed difficulty of further dilation (if required) overall procedural

difficulty ability to complete the procedure on first attempt subject acceptability (pain scores adverse

effects preferences)

Other Outcomes Side effects (pain nausea vomiting diarrhea chills) Immediate complications

Notes

Risk of bias


Allocation concealment Yes Assignment by sequentially numbered opaque en-

velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987

Methods Randomized double-blind Trial

Table of random numbers to select random permuted blocks of six

Single center (Midtown Hospital Atlanta Georgia USA)

Using initial cervical dilation of 37 French units as a dichotomous variable to demonstrate a 2x increase

over the 16 rate with laminaria power of 80 and alpha of 005 (two-tailed) 111 patients per group

Funding support not stated

No statement of ethics committee approval


Participants Inclusion Women seeking abortion procedures between 14-16 weeks gestational age confirmed by ul-

trasound (BPD 25-33mm)

Exclusion None stated


Study dates February 4 1984 to December 21 1985

Interventions Two groups Lamicel group had a 5mm Lamicel inserted if 5mm would not fit a 3mm diameter Lamicel

was used Laminaria group had multiple laminaria placed medium sized dilators until snug then small

until cervix tightly packed or patient could no longer tolerate Both groups had dilators in place for a

minimum of two hours

Outcomes Primary Outcome Cervical dilation measured by if larger than 37 French units prior to procedure ability

to dilate to 43 French units

Secondary Outcomes Vasovagal reaction bleeding upon removal of dilators cervical injury

Other Outcomes Immediate complications

Notes Cost of the devices also mentioned by authors Each lamicel costs $450each laminaria $200each mean

cost of treatment for patients with laminaria is then $1080

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized

List generated from a table of random numbers

Center not noted

No specification of sample size calculation


No statements of ethics committee approval


Participants Inclusion Women presenting for termination between 17-19 menstrual weeks confirmed by ultrasound

Exclusion None noted


Study dates Not specified

Interventions Two groups Group A received one set of 3-7 small or medium laminaria tents and the abortions performed

the next morning Group B returned on the second day for removal of the first set of laminaria and

insertion of a second set of 7-19 tents with the abortion performed on the third day (44-48 hours after

first insertion of laminaria)

Outcomes Primary Outcome Cervical dilation (1) prior to laminaria placement (2) immediately prior to abortion

(3) follow-up visit 2 weeks post abortion based on largest Hegar dilator that passed without resistance

Secondary Outcomes Procedure time (start of uterine evacuation to removal of instruments) pain

estimated blood loss

Other Outcomes Immediate complications 24-hour phone number for emergency use and questionnaire

administered to return by mail 3-month questionnaire mailed

Notes

Risk of bias


Allocation concealment Unclear Not specified

Blinding

All outcomes

No

Zamblera 1994

Methods Randomized

Drawing concealed card for each patient assignment group

Termination of pregnancy (TOP) clinic Kings College Hospital London

No specification of sample size calculation sample size of 50 patients chosen for a feasibility study

Funding by Kings College

Study reviewed by local research ethics committee at Kings College

Published as preliminary study to determine feasibility of formal long-term trial

Participants Inclusion Women presenting for termination between 15-20 weeks confirmed by ultrasound





Zamblera 1994 (Continued)


Interventions Two groups Hypan 3x55mm (15-17weeks GA) 4x65mm (18-20weeks GA) placed 24 hours post-

procedure vs 1mg Gemeprost 4-6 hours pre-operatively (nulliparous women received additional 1mg

Gemeprost 2-4 hours pre-operatively)

Outcomes Primary Outcome Dilation based on largest Hawkins dilator that passed without resistance

Secondary Outcomes Ease of dilation (easy moderate difficult) pre-op bleeding pain (pre and post)

side effects (abortion vomiting diarrhea flushes)

Other Outcomes Immediate complications 6-week post-procedure follow-up for delayed complications

Notes

Risk of bias



Blinding

All outcomes

Yes Single-blinded to physician conducting procedure

Characteristics of excluded studies [ordered by study ID]

Study Reason for exclusion

Golland 1989 No patients in the Dilapan or Gemeprost group gt12weeks gestational age

Hackett 1989 Lack of true randomization (assigned based on oddeven terminal digit of hospital medical record)

Hern 1994 Lack of true randomization (first patient chosen with random number table coin flip and then patients were

alternated)

Killick 1985 No patients gt14 weeks gestational age

Kline 1995 Too few patients gt14weeks gestational age

Lauersen 1982 No randomization (participants were assigned but not randomized)

Wells 1989 Lack of true randomization method (assigned based on oddeven terminal digit of hospital medical record)



D A T A A N D A N A L Y S E S

Comparison 1 Osmotic Dilators vs Prostaglandins

Outcome or subgroup titleNo of

studies

No of

participants Statistical method Effect size

1 Initial Dilation (mm) 2 133 Mean Difference (IV Fixed 95 CI) 363 [262 463]

2 Difficult Dilation 2 133 Peto Odds Ratio (Peto Fixed 95 CI) 017 [006 047]

Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks)


studies

No of


1 Procedure TIme 1 69 Mean Difference (IV Fixed 95 CI) -231 [-429 -033]

2 Need for Additional dilation 1 69 Peto Odds Ratio (Peto Fixed 95 CI) 007 [003 017]

3 Nausea 1 69 Peto Odds Ratio (Peto Fixed 95 CI) 083 [032 212]

4 Vomiting 1 69 Peto Odds Ratio (Peto Fixed 95 CI) 108 [042 279]

5 Diarrhea 1 69 Peto Odds Ratio (Peto Fixed 95 CI) 090 [026 311]

6 Fevers 1 69 Peto Odds Ratio (Peto Fixed 95 CI) 092 [006 1498]

7 Chills 1 69 Peto Odds Ratio (Peto Fixed 95 CI) 090 [026 311]

Comparison 3 Hypan vs Gemeprost (15-20 weeks)


studies

No of


1 Spotting 1 50 Peto Odds Ratio (Peto Fixed 95 CI) 012 [002 090]

2 Pain 1 50 Peto Odds Ratio (Peto Fixed 95 CI) 013 [003 048]

Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks)


studies

No of


1 Procedure Time 1 125 Mean Difference (IV Fixed 95 CI) -005 [-101 091]

2 Initial Dilation (mm) 1 125 Mean Difference (IV Fixed 95 CI) 150 [-063 363]

3 Difficult Dilation ( yes) 1 125 Peto Odds Ratio (Peto Fixed 95 CI) 054 [026 112]

4 Cramps after cervical preparation 1 126 Peto Odds Ratio (Peto Fixed 95 CI) 025 [012 053]

5 Need for Additional Dilation (

yes)

1 125 Peto Odds Ratio (Peto Fixed 95 CI) 171 [085 344]



Comparison 5 Misoprostol (vaginal or sub-lingual) Alone vs Misoprostol (vaginal or sub-lingual) and Mifepris-

tone (14-20 weeks)


studies

No of



2 Need for Additional Dilation 1 692 Peto Odds Ratio (Peto Fixed 95 CI) 162 [120 220]

3 Procedure time (min) 1 692 Mean Difference (IV Fixed 95 CI) 20 [116 284]

4 GI effects (nausea vomiting

diarrhea)



6 Pre-procedural Expulsion

Abortion


Comparison 6 Laminaria vs Lamicel (14-16 weeks)


studies

No of


1 Need for dilation beyond 37

French units


2 Adequate Initial Dilation (gt or =

37 French units)


Comparison 7 One- vs Two-Day Laminaria Placement (17-19 weeks)


studies

No of


1 Procedure Time (min) 1 60 Mean Difference (IV Fixed 95 CI) -030 [-193 133]




Analysis 11 Comparison 1 Osmotic Dilators vs Prostaglandins Outcome 1 Initial Dilation (mm)

Review Cervical preparation for second trimester dilation and evacuation


Outcome 1 Initial Dilation (mm)

Study or subgroup Osmotic Dilators Prostaglandins Mean Difference Weight Mean Difference

N Mean(SD) N Mean(SD) IVFixed95 CI IVFixed95 CI

Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]

Heterogeneity Chi2 = 272 df = 1 (P = 010) I2 =63

Test for overall effect Z = 709 (P lt 000001)

-10 -5 0 5 10

Favors prostaglandins Favors osmotic dilators

Analysis 12 Comparison 1 Osmotic Dilators vs Prostaglandins Outcome 2 Difficult Dilation



Outcome 2 Difficult Dilation

Study or subgroup Osmotic Dilators Prostaglandins Peto Odds Ratio Weight Peto Odds Ratio

nN nN PetoFixed95 CI PetoFixed95 CI

Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]

Total events 2 (Osmotic Dilators) 15 (Prostaglandins)


Test for overall effect Z = 341 (P = 000064)

001 01 1 10 100

Diff w prostaglandin Diff w dilator



Analysis 21 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 1 Procedure TIme



Outcome 1 Procedure TIme

Study or subgroup Laminaria Misoprostol Mean Difference Weight Mean Difference


Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]

Heterogeneity not applicable


-4 -2 0 2 4

Shorter with Laminaria Shorter with Misoprostol

Analysis 22 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 2 Need for Additional

dilation



Outcome 2 Need for Additional dilation

Study or subgroup Laminaria Misoprostol Peto Odds Ratio Weight Peto Odds Ratio


Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]

Total events 6 (Laminaria) 28 (Misoprostol)



0005 01 1 10 200

More need w misoprostol More need w laminaria



Analysis 23 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 3 Nausea



Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5

Nausea with misoprostol Nausea with laminaria

Analysis 24 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 4 Vomiting



Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2

Emesis with misoprostol Emesis with laminaria



Analysis 25 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 5 Diarrhea



Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5

Diarrhea with misoprostol Diarrhea with laminaria

Analysis 26 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 6 Fevers



Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100

Fever with misoprostol Fever with laminaria



Analysis 27 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 7 Chills



Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100

Chills with misoprostol Chills with laminaria

Analysis 31 Comparison 3 Hypan vs Gemeprost (15-20 weeks) Outcome 1 Spotting



Outcome 1 Spotting

Study or subgroup Hypan Gemeprost Peto Odds Ratio Weight Peto Odds Ratio


Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]

Total events 0 (Hypan) 4 (Gemeprost)



0001 001 01 1 10 100 1000

Spotting with gemeprost Spotting with Hypan



Analysis 32 Comparison 3 Hypan vs Gemeprost (15-20 weeks) Outcome 2 Pain



Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100

Pain with Gemeprost Pain with Hypan

Analysis 41 Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) Outcome 1 Procedure

Time



Outcome 1 Procedure Time

Study or subgroup Laminaria and Misoprostol Laminaria Alone Mean Difference Weight Mean Difference


Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1

Shorter w combination Shorter w laminaria



Analysis 42 Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) Outcome 2 Initial Dilation

(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4

Favors laminaria alone Favors combination

Analysis 43 Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) Outcome 3 Difficult

Dilation ( yes)



Outcome 3 Difficult Dilation ( yes)

Study or subgroup Laminaria and Misoprostol Laminaria Alone Peto Odds Ratio Weight Peto Odds Ratio


Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]

Total events 18 (Laminaria and Misoprostol) 28 (Laminaria Alone)



02 05 1 2 5

Favors combination Favors laminaria alone



Analysis 44 Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) Outcome 4 Cramps after

cervical preparation



Outcome 4 Cramps after cervical preparation

Study or subgroup Laminaria Alone Laminaria and Misoprostol Peto Odds Ratio Weight Peto Odds Ratio


Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]

Total events 33 (Laminaria Alone) 51 (Laminaria and Misoprostol)



005 02 1 5 20


Analysis 45 Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) Outcome 5 Need for

Additional Dilation ( yes)



Outcome 5 Need for Additional Dilation ( yes)



Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5

More need w combination More need w laminaria



Analysis 51 Comparison 5 Misoprostol (vaginal or sub-lingual) Alone vs Misoprostol (vaginal or sub-lingual)

and Mifepristone (14-20 weeks) Outcome 1 Initial Dilation (mm)


Comparison 5 Misoprostol (vaginal or sub-lingual) Alone vs Misoprostol (vaginal or sub-lingual) and Mifepristone (14-20 weeks)


Study or subgroup Misoprostol-mifepristone Misoprostol alone Mean Difference Weight Mean Difference


Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4

Favors misoprostol Favors combination


and Mifepristone (14-20 weeks) Outcome 2 Need for Additional Dilation



Outcome 2 Need for Additional Dilation

Study or subgroup Misoprostol-mifepristone Misoprostol alone Peto Odds Ratio Weight Peto Odds Ratio


Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]

Total events 192 (Misoprostol-mifepristone) 196 (Misoprostol alone)



05 07 1 15 2

More need w misoprostol More need w combination




and Mifepristone (14-20 weeks) Outcome 3 Procedure time (min)



Outcome 3 Procedure time (min)



Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2

Longer w misoprostol Longer w combination


and Mifepristone (14-20 weeks) Outcome 4 GI effects (nausea vomiting diarrhea)



Outcome 4 GI effects (nausea vomiting diarrhea)



Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5

Less GI effects with miso More GI effects with comb




and Mifepristone (14-20 weeks) Outcome 5 Spotting



Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5

Spotting with misoprostol Spotting with combination


and Mifepristone (14-20 weeks) Outcome 6 Pre-procedural Expulsion Abortion



Outcome 6 Pre-procedural Expulsion Abortion



Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100

Misoprostol Combination



Analysis 61 Comparison 6 Laminaria vs Lamicel (14-16 weeks) Outcome 1 Need for dilation beyond 37

French units



Outcome 1 Need for dilation beyond 37 French units

Study or subgroup Laminaria Lamicel Peto Odds Ratio Weight Peto Odds Ratio


Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]

Total events 86 (Laminaria) 98 (Lamicel)



01 02 05 1 2 5 10

Favors laminaria Favors lamicel

Analysis 62 Comparison 6 Laminaria vs Lamicel (14-16 weeks) Outcome 2 Adequate Initial Dilation (gt or

= 37 French units)



Outcome 2 Adequate Initial Dilation (gt or = 37 French units)



Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2

Favors lamicel Favors laminaria



Analysis 71 Comparison 7 One- vs Two-Day Laminaria Placement (17-19 weeks) Outcome 1 Procedure

Time (min)



Outcome 1 Procedure Time (min)

Study or subgroup Two-Day One-Day Mean Difference Weight Mean Difference


Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2

Shorter w two-day Shorter w one-day

Analysis 72 Comparison 7 One- vs Two-Day Laminaria Placement (17-19 weeks) Outcome 2 Initial

Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4

Favors one-day Favors two-day



H I S T O R Y

Protocol first published Issue 3 2008

Review first published Issue 8 2010

Date Event Description

10 January 2008 New citation required and major changes Substantive amendment

C O N T R I B U T I O N S O F A U T H O R S

SJ Newmann developed the concept for the review and wrote the protocol reviewed and modified initial searches reviewed discussed

and conceived of relevant interventions and outcomes for analysis systematically reviewed relevant articles and selected those to be

included in the review confirmed data entry from all included reviews contacted authors for additional information and drafted and

revised the final review

A Dalve-Endres reviewed and modified initial searches reviewed discussed and conceived of relevant interventions and outcomes

for analysis systematically reviewed relevant articles and selected those to be included in the review extracted data from all included

reviews contacted authors for additional information entered data into RevMan 50 and drafted the review

JT Diedrich reviewed and modified initial searches reviewed discussed and conceived of relevant interventions and outcomes for

analysis systematically reviewed relevant articles and selected those to be included in the review extracted data from all included

reviews contacted authors for additional information entered data protocol and references into RevMan 50 and assisted in drafting

the review

J Steinauer reviewed discussed and conceived of relevant interventions and outcomes for analysis and edited the review

K Meckstroth provided specific expertise on misoprostol reviewed discussed and conceived of relevant interventions and outcomes

for analysis and edited the review

EA Drey reviewed discussed and conceived of relevant interventions and outcomes for analysis and edited the review

D E C L A R A T I O N S O F I N T E R E S T

None of the authors declared a conflict of interest

S O U R C E S O F S U P P O R T

Internal sources

bull No sources of support provided Not specified



External sources


D I F F E R E N C E S B E T W E E N P R O T O C O L A N D R E V I E W

None

N O T E S

None

I N D E X T E R M S

Medical Subject Headings (MeSH)

lowastAbortifacient Agents lowastProstaglandins Abortion Induced [lowastmethods] Cervix Uteri [lowastdrug effects physiology] Extraction Obstetrical

[methods] Labor Stage First [drug effects physiology] Laminaria Mifepristone Misoprostol Osmosis Polymers Pregnancy Trimester

Second Preoperative Care [lowastmethods]

MeSH check words

Female Humans Pregnancy



T A B L E O F C O N T E N T S

1HEADER

1ABSTRACT

2PLAIN LANGUAGE SUMMARY

3BACKGROUND

4OBJECTIVES

4METHODS

5RESULTS

Figure 1 7

Figure 2 8

Figure 3 8

Figure 4 9

Figure 5 9

Figure 6 10

Figure 7 10

Figure 8 10

Figure 9 10

Figure 10 11

Figure 11 11

Figure 12 11

Figure 13 12

Figure 14 12

Figure 15 12

Figure 16 13

Figure 17 13

Figure 18 13

Figure 19 13

Figure 20 14

Figure 21 14

Figure 22 14

Figure 23 14

Figure 24 15

Figure 25 15

Figure 26 15

16DISCUSSION

17AUTHORSrsquo CONCLUSIONS

17ACKNOWLEDGEMENTS

18REFERENCES

19CHARACTERISTICS OF STUDIES

26DATA AND ANALYSES

Analysis 11 Comparison 1 Osmotic Dilators vs Prostaglandins Outcome 1 Initial Dilation (mm) 28

Analysis 12 Comparison 1 Osmotic Dilators vs Prostaglandins Outcome 2 Difficult Dilation 28

Analysis 21 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 1 Procedure TIme 29

Analysis 22 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 2 Need for Additional dilation 29

Analysis 23 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 3 Nausea 30

Analysis 24 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 4 Vomiting 30

Analysis 25 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 5 Diarrhea 31

Analysis 26 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 6 Fevers 31

Analysis 27 Comparison 2 Laminaria vs Misoprostol (14 - 15 67 weeks) Outcome 7 Chills 32

Analysis 31 Comparison 3 Hypan vs Gemeprost (15-20 weeks) Outcome 1 Spotting 32

Analysis 32 Comparison 3 Hypan vs Gemeprost (15-20 weeks) Outcome 2 Pain 33

Analysis 41 Comparison 4 Laminaria +- Buccal Misoprostol (13-20 67 weeks) Outcome 1 Procedure Time 33

iCervical preparation for second trimester dilation and evacuation (Review)





preparation 35


( yes) 35















units) 39



40HISTORY





42NOTES

42INDEX TERMS
















10100214651858CD007310pub2


A B S T R A C T

Background










Objectives




Search strategy


Selection criteria







Main results





















































B A C K G R O U N D




















acceptability

































































O B J E C T I V E S







and satisfaction

M E T H O D S


Types of studies













tion methods







terectomy)


























labour[ti])




































Strategy 1













Strategy 2



















OR labour)ti






























R E S U L T S



studies


studies













































































prostol































(Zamblera 1994)







(Zamblera 1994)

Allocation








Loss to follow-up
















Zamblera 1994)





Zamblera 1994)

Blinding

























Cervical Dilation























(mm)













a difference













Figure 5)















































Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words







preparation 35


( yes) 35















units) 39



40HISTORY





42NOTES

42INDEX TERMS
















10100214651858CD007310pub2


A B S T R A C T

Background










Objectives




Search strategy


Selection criteria







Main results





















































B A C K G R O U N D




















acceptability

































































O B J E C T I V E S







and satisfaction

M E T H O D S


Types of studies













tion methods







terectomy)


























labour[ti])




































Strategy 1













Strategy 2



















OR labour)ti






























R E S U L T S



studies


studies













































































prostol































(Zamblera 1994)







(Zamblera 1994)

Allocation








Loss to follow-up
















Zamblera 1994)





Zamblera 1994)

Blinding

























Cervical Dilation























(mm)













a difference













Figure 5)















































Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words

















10100214651858CD007310pub2


A B S T R A C T

Background










Objectives




Search strategy


Selection criteria







Main results





















































B A C K G R O U N D




















acceptability

































































O B J E C T I V E S







and satisfaction

M E T H O D S


Types of studies













tion methods







terectomy)


























labour[ti])




































Strategy 1













Strategy 2



















OR labour)ti






























R E S U L T S



studies


studies













































































prostol































(Zamblera 1994)







(Zamblera 1994)

Allocation








Loss to follow-up
















Zamblera 1994)





Zamblera 1994)

Blinding

























Cervical Dilation























(mm)













a difference













Figure 5)















































Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words




Main results





















































B A C K G R O U N D




















acceptability

































































O B J E C T I V E S







and satisfaction

M E T H O D S


Types of studies













tion methods







terectomy)


























labour[ti])




































Strategy 1













Strategy 2



















OR labour)ti






























R E S U L T S



studies


studies













































































prostol































(Zamblera 1994)







(Zamblera 1994)

Allocation








Loss to follow-up
















Zamblera 1994)





Zamblera 1994)

Blinding

























Cervical Dilation























(mm)













a difference













Figure 5)















































Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words









B A C K G R O U N D




















acceptability

































































O B J E C T I V E S







and satisfaction

M E T H O D S


Types of studies













tion methods







terectomy)


























labour[ti])




































Strategy 1













Strategy 2



















OR labour)ti






























R E S U L T S



studies


studies













































































prostol































(Zamblera 1994)







(Zamblera 1994)

Allocation








Loss to follow-up
















Zamblera 1994)





Zamblera 1994)

Blinding

























Cervical Dilation























(mm)













a difference













Figure 5)















































Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words










O B J E C T I V E S







and satisfaction

M E T H O D S


Types of studies













tion methods







terectomy)


























labour[ti])




































Strategy 1













Strategy 2



















OR labour)ti






























R E S U L T S



studies


studies













































































prostol































(Zamblera 1994)







(Zamblera 1994)

Allocation








Loss to follow-up
















Zamblera 1994)





Zamblera 1994)

Blinding

























Cervical Dilation























(mm)













a difference













Figure 5)















































Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words













Strategy 1













Strategy 2



















OR labour)ti






























R E S U L T S



studies


studies













































































prostol































(Zamblera 1994)







(Zamblera 1994)

Allocation








Loss to follow-up
















Zamblera 1994)





Zamblera 1994)

Blinding

























Cervical Dilation























(mm)













a difference













Figure 5)















































Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words



























































prostol































(Zamblera 1994)







(Zamblera 1994)

Allocation








Loss to follow-up
















Zamblera 1994)





Zamblera 1994)

Blinding

























Cervical Dilation























(mm)













a difference













Figure 5)















































Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words






Loss to follow-up
















Zamblera 1994)





Zamblera 1994)

Blinding

























Cervical Dilation























(mm)













a difference













Figure 5)















































Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words














a difference













Figure 5)















































Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words
















































Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words





Additional dilation













Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words








Procedure Time
























Procedure TIme




Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words





Procedure Time





Side Effects
























(Figure 24)
































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words

































Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words
























Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words


















Complications





















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words
















18)


























D I S C U S S I O N














































































be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words




















be limited
















dures by DampE
































R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words




R E F E R E N C E S






200775(3)230ndash7













887ndash90
































(8)890ndash894



161(5)1124ndash1126


Altman 1985




198530(8)601ndash6

Behrman 2007




Bierer 1972




Castleman 2006





Chvapil 1982



729ndash33

Darney 1986



13(1)43ndash51

Eaton 1972




FEMA 2003




wwwdilapancompdf




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words




Finer 2005




Fox 2007



486ndash95

Grimes 1984




Herczeg 1986




Higgins 2009



2009

Kalish 2002




2002187(4)882ndash5

Karim 1971




197178(4)294ndash300

Krammer 1995



Lichtenberg 2004



Lohr 2008




10100214651858CD006714pub2 58CD006714pub2]

Munsick 1996



87(5 pt 1)726ndash9

Newmann 2008




Newton 1972



442ndash8

Patel 2006





Peterson 1983




Poon 2007





RCOG 2004



Schulz 1983



1182ndash5

Stat Service 2005



Todd 2002




Van Den Bergh 1976



WHO 1997




WHO 2003



30

Wiquist 1970







Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words






Carbonell 2007







performed



















complications


Risk of bias



opaque envelopes

Blinding

All outcomes




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words




Edelman 2006














enrolment period)













Risk of bias



Blinding

All outcomes

Yes Double-blinded



Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words




Goldberg 2005







and Policy










procedure)









Notes

Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words




Grimes 1987
























Risk of bias



velopes

Blinding

All outcomes

Yes Double-blinded



Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words




Stubblefield 1984

Methods Randomized


Center not noted



















Notes

Risk of bias



Blinding

All outcomes

No

Zamblera 1994

Methods Randomized





















Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words













Notes

Risk of bias



Blinding

All outcomes







alternated)










studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words







studies

No of






studies

No of











studies

No of






studies

No of







yes)





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words





tone (14-20 weeks)


studies

No of






diarrhea)




Abortion




studies

No of



French units



37 French units)




studies

No of












Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words










Goldberg 2005 42 143 (26) 41 11 (24) 869 330 [ 222 438 ]

Zamblera 1994 25 145 (5) 25 87 (5) 131 580 [ 303 857 ]

Total (95 CI) 67 66 1000 363 [ 262 463 ]



-10 -5 0 5 10








Goldberg 2005 242 1141 747 019 [ 006 062 ]

Zamblera 1994 025 425 253 012 [ 002 090 ]

Total (95 CI) 67 66 1000 017 [ 006 047 ]




001 01 1 10 100










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words










Goldberg 2005 36 502 (406) 33 733 (431) 1000 -231 [ -429 -033 ]

Total (95 CI) 36 33 1000 -231 [ -429 -033 ]



-4 -2 0 2 4



dilation






Goldberg 2005 636 2833 1000 007 [ 003 017 ]

Total (95 CI) 36 33 1000 007 [ 003 017 ]




0005 01 1 10 200







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words







Outcome 3 Nausea



Goldberg 2005 1936 1933 1000 083 [ 032 212 ]

Total (95 CI) 36 33 1000 083 [ 032 212 ]




02 05 1 2 5





Outcome 4 Vomiting



Goldberg 2005 1636 1433 1000 108 [ 042 279 ]

Total (95 CI) 36 33 1000 108 [ 042 279 ]




05 07 1 15 2







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words







Outcome 5 Diarrhea



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




02 05 1 2 5





Outcome 6 Fevers



Goldberg 2005 136 133 1000 092 [ 006 1498 ]

Total (95 CI) 36 33 1000 092 [ 006 1498 ]




001 01 1 10 100







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words







Outcome 7 Chills



Goldberg 2005 636 633 1000 090 [ 026 311 ]

Total (95 CI) 36 33 1000 090 [ 026 311 ]




001 01 1 10 100





Outcome 1 Spotting



Zamblera 1994 025 425 1000 012 [ 002 090 ]

Total (95 CI) 25 25 1000 012 [ 002 090 ]




0001 001 01 1 10 100 1000







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words







Outcome 2 Pain



Zamblera 1994 125 1025 1000 013 [ 003 048 ]

Total (95 CI) 25 25 1000 013 [ 003 048 ]




001 01 1 10 100



Time






Edelman 2006 64 69 (26) 61 695 (285) 1000 -005 [ -101 091 ]

Total (95 CI) 64 61 1000 -005 [ -101 091 ]



-1 -05 0 05 1





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words





(mm)






Edelman 2006 61 4845 (615) 64 4695 (601) 1000 150 [ -063 363 ]

Total (95 CI) 61 64 1000 150 [ -063 363 ]



-4 -2 0 2 4



Dilation ( yes)






Edelman 2006 1861 2864 1000 054 [ 026 112 ]

Total (95 CI) 61 64 1000 054 [ 026 112 ]




02 05 1 2 5











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words











Edelman 2006 3364 5162 1000 025 [ 012 053 ]

Total (95 CI) 64 62 1000 025 [ 012 053 ]




005 02 1 5 20









Edelman 2006 3764 2761 1000 171 [ 085 344 ]

Total (95 CI) 64 61 1000 171 [ 085 344 ]




02 05 1 2 5











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words











Carbonell 2007 306 136 (21) 386 86 (32) 1000 500 [ 460 540 ]

Total (95 CI) 306 386 1000 500 [ 460 540 ]



-4 -2 0 2 4









Carbonell 2007 192306 196386 1000 162 [ 120 220 ]

Total (95 CI) 306 386 1000 162 [ 120 220 ]




05 07 1 15 2











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words











Carbonell 2007 306 142 (63) 386 122 (45) 1000 200 [ 116 284 ]

Total (95 CI) 306 386 1000 200 [ 116 284 ]



-2 -1 0 1 2









Carbonell 2007 79306 39386 1000 303 [ 204 452 ]

Total (95 CI) 306 386 1000 303 [ 204 452 ]




02 05 1 2 5








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words








Outcome 5 Spotting



Carbonell 2007 14306 18386 1000 098 [ 048 200 ]

Total (95 CI) 306 386 1000 098 [ 048 200 ]




02 05 1 2 5









Carbonell 2007 17306 3386 1000 547 [ 224 1340 ]

Total (95 CI) 306 386 1000 547 [ 224 1340 ]




001 01 1 10 100





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words





French units






Grimes 1987 86110 98109 1000 042 [ 020 086 ]

Total (95 CI) 110 109 1000 042 [ 020 086 ]




01 02 05 1 2 5 10



= 37 French units)






Grimes 1987 52110 52109 1000 098 [ 058 167 ]

Total (95 CI) 110 109 1000 098 [ 058 167 ]




05 07 1 15 2





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words





Time (min)






Stubblefield 1984 28 63 (27) 32 66 (37) 1000 -030 [ -193 133 ]

Total (95 CI) 28 32 1000 -030 [ -193 133 ]



-2 -1 0 1 2



Dilation (mm)






Stubblefield 1984 28 224 (3) 32 182 (24) 1000 420 [ 281 559 ]

Total (95 CI) 28 32 1000 420 [ 281 559 ]



-4 -2 0 2 4




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words




H I S T O R Y
















the review








Internal sources




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words




External sources



None

N O T E S

None

I N D E X T E R M S





MeSH check words




Cervical preparation for second trimester dilation and evacuation

Documents