Nitric oxide donors for cervical ripening in first‐trimester surgical abortion

Patama Promsonthi; Domerudee Preechapornprasert; Boonsri Chanrachakul

doi:10.1002/14651858.CD007444.pub3

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Figure 1

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.1 Baseline cervical dilatation before the procedure.

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Figure 2

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.2 Cumulative force required to dilate cervix to 8 mm.

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Figure 3

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.3 Side effects: Headache.

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Figure 4

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.4 Side effect: Abdominal pain.

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Figure 5

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.6 Patient satisfaction.

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Figure 6

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.5 Side effect: Nausea/vomiting.

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Figure 7

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.1 Cumulative force required to dilate cervix to 8‐9 mm.

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Figure 8

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.2 Baseline cervical dilatation before the procedure.

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Figure 9

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.11 Probability of reaching cervical ripening > 8 mm at 3 hours.

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Figure 10

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.3 Side effect: Headache.

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Figure 11

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.6 Side effect: Palpitation.

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Figure 12

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.7 Side effect: Dizziness.

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Figure 13

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.4 Side effect: Abdominal pain.

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Figure 14

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.5 Side effect: Vaginal bleeding.

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Figure 15

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.8 Side effect: Nausea/Vomiting.

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Figure 16

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.10 Patient satisfaction.

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Figure 17

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.9 Intraoperative blood loss.

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Figure 18

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.1 Cumulative force required to dilate cervix to 8 mm.

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Figure 19

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.2 Side effect: Headache.

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Figure 20

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.3 Side effect: Abdominal pain.

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Figure 21

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.4 Intraoperative blood loss.

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Analysis 1.1

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 1 Baseline cervical dilatation before the procedure.

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Analysis 1.2

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 2 Cumulative force required to dilate cervix to 8 mm.

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Analysis 1.3

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 3 Side effects: Headache.

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Analysis 1.4

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 4 Side effect: Abdominal pain.

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Analysis 1.5

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 5 Side effect: Nausea/vomiting.

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Analysis 1.6

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 6 Patient satisfaction.

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Analysis 2.1

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 1 Cumulative force required to dilate cervix to 8‐9 mm.

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Analysis 2.2

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 2 Baseline cervical dilatation before the procedure.

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Analysis 2.3

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 3 Probability of reaching cervical ripening > 8 mm at 3 hours.

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Analysis 2.4

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 4 Side effect: Headache.

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Analysis 2.5

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 5 Side effect: Palpitation.

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Analysis 2.6

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 6 Side effect: Dizziness.

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Analysis 2.7

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 7 Side effect: Abdominal pain.

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Analysis 2.8

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 8 Side effect: Vaginal bleeding.

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Analysis 2.9

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 9 Side effect: Nausea/Vomiting.

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Analysis 2.10

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 10 Patient satisfaction.

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Analysis 2.11

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 11 Intraoperative blood loss.

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Analysis 3.1

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 1 Cumulative force required to dilate cervix to 8 mm.

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Analysis 3.2

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 2 Side effect: Headache.

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Analysis 3.3

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 3 Side effect: Abdominal pain.

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Analysis 3.4

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 4 Intraoperative blood loss.

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Comparison 1. Nitric oxide donors versus placebo or no treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Baseline cervical dilatation before the procedure Show forest plot	3	168	Mean Difference (IV, Fixed, 95% CI)	0.30 [0.01, 0.58]

2 Cumulative force required to dilate cervix to 8 mm Show forest plot	3	153	Mean Difference (IV, Fixed, 95% CI)	‐4.29 [‐9.92, 1.35]

3 Side effects: Headache Show forest plot	3	165	Risk Ratio (M‐H, Fixed, 95% CI)	1.73 [0.86, 3.46]

4 Side effect: Abdominal pain Show forest plot	2	117	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.50, 1.50]

5 Side effect: Nausea/vomiting Show forest plot	3	165	Risk Ratio (M‐H, Fixed, 95% CI)	2.62 [1.07, 6.45]

6 Patient satisfaction Show forest plot	1	84	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.84, 1.07]

Comparison 1. Nitric oxide donors versus placebo or no treatment

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Comparison 2. Nitric oxide donors versus prostaglandins

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cumulative force required to dilate cervix to 8‐9 mm Show forest plot	5	429	Mean Difference (IV, Fixed, 95% CI)	13.12 [9.72, 16.52]

2 Baseline cervical dilatation before the procedure Show forest plot	4	386	Mean Difference (IV, Fixed, 95% CI)	‐0.73 [‐1.01, ‐0.45]

3 Probability of reaching cervical ripening > 8 mm at 3 hours Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	6.67 [2.21, 20.09]

4 Side effect: Headache Show forest plot	5	507	Risk Ratio (M‐H, Fixed, 95% CI)	5.13 [3.29, 8.00]

5 Side effect: Palpitation Show forest plot	4	447	Risk Ratio (M‐H, Fixed, 95% CI)	3.43 [1.64, 7.15]

6 Side effect: Dizziness Show forest plot	3	327	Risk Ratio (M‐H, Fixed, 95% CI)	3.29 [1.46, 7.41]

7 Side effect: Abdominal pain Show forest plot	5	507	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.25, 0.44]

8 Side effect: Vaginal bleeding Show forest plot	4	447	Risk Ratio (M‐H, Fixed, 95% CI)	0.14 [0.07, 0.27]

9 Side effect: Nausea/Vomiting Show forest plot	5	507	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.94, 1.46]

10 Patient satisfaction Show forest plot	1	84	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.92, 1.28]

11 Intraoperative blood loss Show forest plot	4	393	Mean Difference (IV, Fixed, 95% CI)	33.59 [24.50, 42.67]

Comparison 2. Nitric oxide donors versus prostaglandins

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Comparison 3. Nitric oxide donor versus nitric oxide donor and prostaglandin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cumulative force required to dilate cervix to 8 mm Show forest plot	1	44	Mean Difference (IV, Fixed, 95% CI)	14.5 [0.50, 28.50]

2 Side effect: Headache Show forest plot	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.38, 2.00]

3 Side effect: Abdominal pain Show forest plot	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.14 [0.02, 1.07]

4 Intraoperative blood loss Show forest plot	1	44	Mean Difference (IV, Fixed, 95% CI)	‐50.0 [‐164.19, 64.19]

Comparison 3. Nitric oxide donor versus nitric oxide donor and prostaglandin

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