Comparison of sublingual and vaginal misoprostol in cervical ripening before hysteroscopy in infertile patients

Abstract

Objective: To compare the effects of 400 µg Misoprostol administered through vaginal and sublingual route for preoperative cervical ripening in infertile patients prior to hysteroscopy and to study the side effects and complications. Methods: This hospital based prospective double-blind study was conducted on 88 infertile patients posted for hysteroscopy. A pre-treatment Hegar's dilator test was done and findings noted for all patients. Randomization of patients was done by flip of coin method for administration of 400 µg Misoprostol sublingually or vaginally 8-12 hours prior to surgery. The primary outcome in this study was the postoperative cervical width as measured by the largest number of Hegar dilator that could be inserted without resistance. The side effects and complications during surgery for each group were also noted. Results: Patients were randomized to receive sublingual (n = 44) and vaginal (n = 44) Misoprostol. The groups were comparable in terms of age, parity, rural/urban, history of vaginal delivery and surgeon type. The preoperative cervical width in the sublingual group: 0.34 ± 0.67mm and vaginal group: 0.29 ± 0.54 mm was statistically similar among both groups. The post-operative cervical width in the sublingual group was 6.45 ± 1.19 and vaginal group was 8.27 ± 1.11.The difference between the two groups was found to be statistically significant (p value<0.01) though the side effects and complications during the hysteroscopy were comparable. Conclusion:The outcome of cervical ripening with Misoprostol prior to hysteroscopy in young infertility patients by the sublingual and vaginal routes, vaginal administration is more effective than sublingual route.