A double-blind randomized controlled trial of two different doses of misoprostol for cervical priming prior to office hysteroscopy

El-Khayat, Waleed; Dwidar, Login; Elsawah, Heba; Idris, Omima

doi:10.1016/j.mefs.2014.03.004

Cited by 4 publications

(15 citation statements)

References 23 publications

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“…In the study by Waleed El-Khayat et al while comparing the efficacy of 200 and 400μg of vaginal misoprostol 3 hours before surgery abdominal pain was observed with a higher frequency in the 400μg misoprostol group compared to 200μg group (16.7% versus 6.1%). 7 Over all abdominal pain was perceived less frequently than our study.…”

Section: Discussioncontrasting

confidence: 70%

“…We didn't find any significant decrease in the procedural time by merely increasing the dose of the misoprostol. There are however studies in literature with contradictory results to ours, like in the study by Waleed et al 6,7 There are other studies in literature like Bastu E et al that computed procedural time from the beginning of the endoscopic entry to the end of the operative procedure which included polypectomies etc. Their procedural time couldn't hence be compared to our study.…”

Section: Discussionmentioning

confidence: 60%

“…El Khayat W et al compared the effectiveness of 200μg and 400μg of vaginal misoprostol and found that there was no significant difference in the perception of nausea (1.5% in each group), however, in their study misoprostol was administered vaginally only 3 hours prior to surgery which could be the reason. 7 Vahadat et al in their study while evaluating the efficacy of 400μg of vaginal misoprostol 10-12 hours before hysteroscopy also found that nausea was higher in misoprostol group as compared to control, although the difference wasn't statistically significant. 8 Four patients (13.4%) in group 2 in our study experienced vaginal bleeding after administration of misoprostol while as no patient in group 1 had vaginal bleeding (p value= 0.038).…”

Section: Discussionmentioning

confidence: 94%

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Comparative study of efficacy and adverse effects of different doses of vaginal misoprostol for cervical ripening 10-12 hours before diagnostic hysteroscopy

Gupta

Ahmad

Kumari

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Hysteroscopy first described by Panteleoni in 1869 has evolved into a standard procedure for the diagnosis and treatment of intrauterine pathologies such as polyps, fibroids, septae, adhesions, evaluation of abnormal uterine bleeding, evaluation and treatment of infertility, removal of an intrauterine device or foreign body. Present study was carried out to compare the efficacy and complications different doses of vaginal misoprostol for cervical ripening10-12 hours before diagnostic hysteroscopy.Methods: It was a prospective and interventional, double-blinded randomized comparative study. Sixty women, fulfilling the inclusion criteria, requiring diagnostic hysteroscopy for evaluation of infertility were enrolled. The study subjects randomly received either 200μg (group 1) or 400μg (group 2) of vaginal misoprostol 10-12 hours before hysteroscopy with equal number of subjects in both the groups. Hysteroscopy was performed with a standard rigid 6 mm and 300 hysteroscope. The largest dilator that could be inserted without resistance was recorded as the baseline cervical dilatation. The ease of dilatation was recorded on a 5 point LIKERT scale. Procedural time was measured as time taken from the beginning of cervical dilatation to the visualisation of the uterine cavity.Results: The mean base line cervical width in group 1 was 6.41±0.29 mm while in group 2 it was 6.43±0.21 mm (p=0.084). In group 1, 26.6% patients had very easy entry, 53.4% had easy entry while in group 2, 30% patients had very easy entry, 43.4% had easy entry. The mean procedural time 35.5±6.9 seconds in group 1 and 33.2±6.8 seconds in group 2 (p=0.212). Adverse effects like abdominal pain, vaginal bleeding, shivering and fever were observed more often in group 2 compared to group 1(p=0.038).Conclusions: Two hundred microgram of vaginal misoprostol is safer and equally effective as 400 μg for cervical ripening when used 10-12 hours before diagnostic hysteroscopy.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 94%

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Comparative study of efficacy and adverse effects of different doses of vaginal misoprostol for cervical ripening 10-12 hours before diagnostic hysteroscopy

Gupta

Ahmad

Kumari

2018

Int J Reprod Contracept Obstet Gynecol

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“…The literature search yielded 807 records and 24 studies were suitable for systematic review, 18–22,24–42 of which one trial was added after screening the reference lists of included studies 41 . Nineteen studies provided data for meta‐analysis 18–22,24–28,30,34–40,42 …”

Section: Resultsmentioning

confidence: 99%

“…No significant difference ( P = 0.20) in ease of hysteroscopic entry could be found between the two studies (172 women) providing mean (and standard deviation) Likert scale scores investigating the use of 200 μg against 400 μg misoprostol (Figure S13). 18,30 There was, however, a significant reduction in procedural time when 400 μg misoprostol was given (SMD 1.03, 95% CI 0.01–2.05) (Figure S14). In the two studies investigating cervical dilatation achieved before hysteroscopy, there was no significant difference when comparing 200 μg against 400 μg misoprostol 18,37 .…”

Section: Resultsmentioning

confidence: 99%

Cervical dilatation and preparation prior to outpatient hysteroscopy: a systematic review and meta‐analysis

Silva

Wilson

Carnegy

et al. 2020

BJOG

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Background There are uncertainties about the benefit of routine cervical preparation and/or cervical dilatation before outpatient hysteroscopy. Objective To determine if cervical preparation and/or routine mechanical dilatation reduces pain during outpatient hysteroscopy. Search strategy MEDLINE, EMBASE, CINAHL and CENTRAL were searched on 19 October 2020, using keywords ‘hysteroscopy’, ‘cervical preparation’, ‘cervical ripening’, ‘cervical dilatation’, ‘outpatient’, ‘office’ and/or ‘ambulatory’ and associated medical subject headings. Selection criteria Randomised controlled trials investigating the benefit of cervical preparation and/or cervical dilatation on pain in women undergoing outpatient hysteroscopy were included. Data collection and analysis Two independent reviewers selected eligible trials and extracted data on pain, feasibility, adverse events and satisfaction/acceptability for meta‐analysis. Main results The literature search yielded 807 records, of which 24 were included for review and 19 provided data for meta‐analysis. No trials investigated the role of routine mechanical cervical dilatation. Cervical preparation significantly reduced pain during outpatient hysteroscopy; standard mean difference (SMD) ‒0.67, 95% confidence interval (CI) ‒1.05 to ‒0.29. Feasibility also improved as priming provided significantly easier hysteroscopic entry (SMD 0.89, 95% CI 0.32–1.46), greater cervical dilatation (SMD 0.81, 95% CI 0.08–1.53) and shorter procedural times (SMD ‒0.51, 95% CI ‒0.88 to ‒0.13). Cervical preparation, however, incurred significantly more adverse effects, mainly comprising genital tract bleeding, abdominal pain and gastrointestinal symptoms (odds ratio 2.94, 95% CI 1.58–5.47). There were limited data regarding satisfaction, acceptability and complications. Conclusions Cervical preparation reduces pain and improves feasibility associated with outpatient hysteroscopy but increases the risk of adverse effects. Tweetable abstract Cervical preparation before outpatient hysteroscopy reduces pain, enhances feasibility but increases adverse effects.

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Optimal timing of misoprostol administration in nulliparous women undergoing office hysteroscopy: a randomized double-blind placebo-controlled study

Fouda

Allah

Elshaer

2016

Fertility and Sterility

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A double-blind randomized controlled trial of two different doses of misoprostol for cervical priming prior to office hysteroscopy

Cited by 4 publications

References 23 publications

Comparative study of efficacy and adverse effects of different doses of vaginal misoprostol for cervical ripening 10-12 hours before diagnostic hysteroscopy

Comparative study of efficacy and adverse effects of different doses of vaginal misoprostol for cervical ripening 10-12 hours before diagnostic hysteroscopy

Cervical dilatation and preparation prior to outpatient hysteroscopy: a systematic review and meta‐analysis

Optimal timing of misoprostol administration in nulliparous women undergoing office hysteroscopy: a randomized double-blind placebo-controlled study

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