Prostaglandins prior to hysteroscopy

Abstract

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.