Cervical Ripening Using Vaginal Misoprostol before Hysteroscopy: A Double-blind Randomized Trial

Waddell, Guy; Desindes, Sophie; Takser, Larissa; Beauchemin, Marie-Claude; Bessette, Paul

doi:10.1016/j.jmig.2008.08.013

Cited by 35 publications

(28 citation statements)

References 26 publications

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“…The data presented in our study are in accordance with previous studies, which showed that the use of misoprostol before outpatient or inpatient hysteroscopy is often accompanied with unwanted adverse effects [20,23]. Valente et al [23] reported adverse effects in the form of vaginal bleeding (55%), nausea (15%), diarrhea (5%), and fever (5%) after vaginal administration of misoprostol 6 h prior to office hysteroscopy.…”

Section: Misoprostol Prior To Office Hysteroscopysupporting

confidence: 91%

“…da Costa et al [18] found that vaginal misoprostol (200 µg given 8 h before office hysteroscopy) minimized the pain perceived by postmenopausal women during office hysteroscopy. Moreover, 2 studies including both premenopausal and postmenopausal women in their study population revealed that vaginal misoprostol (400 µg administered 4-6 or 12-24 h before the procedure) significantly reduced the pain experienced during office hysteroscopy [19,20].…”

Section: Misoprostol Prior To Office Hysteroscopymentioning

confidence: 97%

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Misoprostol Prior to Diagnostic Office Hysteroscopy in the Subgroup of Patients with No Risk Factors for Cervical Stenosis: A Randomized Double Blind Placebo-Controlled Trial

Fouda

Elsetohy

Elshaer

et al. 2017

Gynecol Obstet Invest

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Aims: To assess the effectiveness of vaginal misoprostol in minimizing the pain perceived by patients with no risk factors for cervical stenosis (i.e., parous women of reproductive age who have no history of cesarean section or cervical surgery) during diagnostic office hysteroscopy. Methods: A total of 100 patients with no risk factors for cervical stenosis were randomized to the misoprostol group (n = 50) or the placebo group (n = 50). In the misoprostol group, 2 misoprostol tablets (400 µg) were administered vaginally 12 h before office hysteroscopy. In the placebo group, 2 placebo tablets were administered. The patients rated the intensity of pain perceived during the procedure and at 30 min after the procedure with the use of a 100 mm visual analog scale (VAS). The hysteroscopists also scored the difficulty of hysteroscope insertion into the uterine cavity with the use of a 100 mm VAS. Results: There were no significant differences between both groups in the VAS pain scores during or at 30 min after the procedure (28.3 ± 13.58 vs. 30.42 ± 15.13 and 11.1 ± 10.23 vs. 13.32 ± 11.12, respectively). The difficulty of hysteroscope insertion into the uterine cavity was comparable between both groups. Conclusion: Misoprostol administration prior to diagnostic office hysteroscopy appears to have no beneficial role in the subgroup of patients with no risk factors for cervical stenosis.

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Section: Misoprostol Prior To Office Hysteroscopysupporting

confidence: 91%

Section: Misoprostol Prior To Office Hysteroscopymentioning

confidence: 97%

Misoprostol Prior to Diagnostic Office Hysteroscopy in the Subgroup of Patients with No Risk Factors for Cervical Stenosis: A Randomized Double Blind Placebo-Controlled Trial

Fouda

Elsetohy

Elshaer

et al. 2017

Gynecol Obstet Invest

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“…Single-site access laparoscopic-assisted vaginal hysterectomy described in recent publications was performed with a wound retractor and a "homemade" multiport access device [3,4]. The various single-site access systems that are available may give rise to different operative outcomes.…”

Section: Conflict Of Interestmentioning

confidence: 99%

Misoprostol for cervical ripening before diagnostic hysteroscopy in nulliparous women

Bakas

Hassiakos

Liapis

et al. 2011

Intl J Gynecology & Obste

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Misoprostol has been used for cervical preparation before diagnostic hysteroscopic procedures, but there is no agreement on the recommended dose, route, or time of administration [1,2]. The aim of the present study was to compare the efficacy of 3 different misoprostol regimens for cervical ripening before diagnostic hysteroscopy in nulliparous women.The present study was conducted at Aretaieio Hospital, Athens, Greece, and LHTO Maternity Hospital, Athens, Greece from March 2005 to November 2010. All participants provided informed consent and the Ethical Committee of Aretaieio Hospital approved the study. Indications for diagnostic hysteroscopy were 3 failed attempts at intrauterine insemination with controlled ovarian stimulation using gonadotropins; at least 1 failed attempt at in vitro fertilization or intracytoplasmic sperm injection; menometrorrhagia; and intrauterine pathology detected by hysterosalpingography or transvaginal ultrasound. Inclusion criteria were nulliparous, premenopausal women who were fit to undergo the procedure. Exclusion criteria were any possible contraindications to the use of prostaglandins; parity; history of previous cervical procedures such as loop excision, cone biopsy, or previous dilatation and curettage; and contraindications to hysteroscopy such as active infection, bleeding, pregnancy, or suspicion of malignancy.Eligible patients were randomly allocated using a computergenerated sequence into 3 groups: group A (n = 39) received 200 μg of misoprostol orally at 12 hours and 6 hours before hysteroscopy; group B (n = 36) received 200 μg of misoprostol vaginally 12 hours before hysteroscopy; and group C (n = 35) received 200 μg of misoprostol vaginally 4 hours before hysteroscopy.Hysteroscopy was performed during the early follicular phase of the cycle. The primary outcome measure was the degree of preoperative cervical dilation required (if the hysteroscope could not be inserted) using Hegar dilators up to size 5 and introduced without force. Secondary outcome measures were time taken to dilation to introduce a Hegar dilator size 5, development of uterine or cervical injury during the procedure, development of intrauterine bands as a result of the procedure, and complications secondary to the use of misoprostol.The characteristics of the patients are shown in Table 1. A significant difference was found in the need for cervical dilation between groups A and C (12.8% vs 74.1%; P b 0.001) and between groups B and C (16.6% vs 74.1%; P b 0.001). In addition, there was a significant difference in the duration of cervical dilation to a size 5 dilator between groups A and C (35.3 ± 18 vs 63.7 ± 23 s; P b 0.001) and between groups B and C (37.5 ± 21 vs 63.7 ± 23 s; P b 0.001) ( Table 2).There were no significant differences in the occurrence of adverse effects between groups A and C, or between groups B and C (P > 0.05) ( Table 3).The group C regimen did not reduce the need for cervical dilation, which supports the findings of Singh et al. [3]. The findings of the present study are in ag...

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“…Prostaglandins had been shown to be effective for cervical ripening in non-pregnant women undergoing hysteroscopic procedures being administered orally or vaginally [11][12][13]. However, misoprostol use via rectal or sublingual route for the same indication was not thoroughly studied and there is scarce evidence to support or decline such role.…”

Section: Discussionmentioning

confidence: 99%

Prostaglandins prior to hysteroscopy

Moiety¹,

Azzam²

2011

Gynecol Surg

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This prospective randomized controlled study was conducted to assess the role of misoprostol, given sublingually or rectally, on the outcome of hysteroscopic procedures. A total of 212 premenopausal patients undergoing hysteroscopic procedures were randomly allocated into three groups: group 1 (n=71), sublingual misoprostal given 2 h before the procedure; group 2 (n=71) rectal misoprostal 2 h before the procedure; group 3 (n=70), control group, no medications were given. Main outcome measures were ease of cervical dilatation, dilatation time to Hegar 6, complications as cervical laceration and postoperative cramps, bleeding and pyrexia. The cervical canal at the start was significantly wider misoprostol groups (P= 0.038). Cervical dilatation was significantly easier in the rectal misoprostol group over control (P=0.035). Misoprostol groups showed significant reduction in the mean time needed to dilate to Hegar 6 (P=0.021). Postoperative pain and cramps were significantly higher in misoprostol groups (P=0.002). Misoprostol before hysteroscopy demonstrates a benefit in the ease of cervical dilatation, cervical width at the start and time for dilatation with low risk of cervical tears. Rectal misoprostol appears advantageous than sublingual one. However, postoperative adverse effects are more common with misoprostol groups.

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Cervical Ripening Using Vaginal Misoprostol before Hysteroscopy: A Double-blind Randomized Trial

Cited by 35 publications

References 26 publications

Misoprostol Prior to Diagnostic Office Hysteroscopy in the Subgroup of Patients with No Risk Factors for Cervical Stenosis: A Randomized Double Blind Placebo-Controlled Trial

Misoprostol Prior to Diagnostic Office Hysteroscopy in the Subgroup of Patients with No Risk Factors for Cervical Stenosis: A Randomized Double Blind Placebo-Controlled Trial

Misoprostol for cervical ripening before diagnostic hysteroscopy in nulliparous women

Prostaglandins prior to hysteroscopy

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