Vaginal misoprostol for cervical priming before operative hysteroscopy: a randomized controlled trial

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 96; no. 6; pp. 890 - 894
• Main Authors: Preutthipan, Sangchai, Herabutya, Yongyoth
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2000; The American College of Obstetricians and Gynecologists; Elsevier Science
• Subjects: Administration, Intravaginal; Adolescent; Adult; Aged; Biological and medical sciences; Cervix Uteri - drug effects; Female; Hormones. Endocrine system; Humans; Hysteroscopy - methods; Leiomyoma - surgery; Medical sciences; Middle Aged; Misoprostol - administration & dosage; Misoprostol - adverse effects; Pharmacology. Drug treatments; Polyps - surgery; Premedication; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Tissue Adhesions - surgery; Uterine Diseases - surgery; Uterine Neoplasms - surgery; Human; Endoscopic surgery; Hysteroscopy; Controlled therapeutic trial; Uterine cervix; Misoprostol; Dilatator; Chemotherapy; Randomization; Vaginal route; Dilatation; Surgery; Female; Influence; Endoscopy; Preoperative; Prostaglandin derivatives
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1016/S0029-7844(00)01063-2

Objective: To investigate the effectiveness of vaginal misoprostol for cervical priming before operative hysteroscopy and to assess the cervicouterine complications related to cervical dilatation and hysteroscopic surgery in nulliparous women. Methods: One hundred fifty-two women with definite intrauterine lesions were randomly assigned to receive either 200 μg vaginal misoprostol or placebo. Cervical response and outcome and complications of operative hysteroscopy were assessed. Results: Thirty-five subjects were needed in each arm to detect a type I error of 0.01 with a power of 0.99. The mean cervical dilatation estimated by Hegar dilator was significantly different between the treated group (7.3 ± 0.7 mm) and the control group (3.8 ± 1.1 mm, P < .001). In the misoprostol group, 55 (75.3%) patients needed cervical dilation, compared with 75 (94.9%, P = .001) in the placebo group. The median time of cervical dilation to Hegar number 9 was significantly shorter in the treated group (40 seconds) compared with the control group (120 seconds, P < .001). The mean operative time was significantly shorter in the treated group (36.4 ± 10.9 minutes) compared with the control group (45.9 ± 14.2 minutes, P < .001). Cervical tears occurred in nine (11.4%) patients in the control group and in one (1.4%, P = .018) in the misoprostol group. Creation of a false tract was more common in the control group. Two uterine perforations occurred in the placebo group. Conclusion: Vaginal misoprostol applied before operative hysteroscopy reduced the need for cervical dilation, facilitated hysteroscopic surgery, and minimized cervical complications.