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ORIGINAL ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 1  |  Page : 59-65

Different routes of misoprostol for same-day cervical priming prior to hysteroscopy: a randomized controlled single-blinded trial


Gynecology and Obstetrics Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Correspondence Address:
MD Mazen A El Zahry
Al Azhar University Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjamf.sjamf_112_19

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Introduction Hysteroscopic surgery, with prior cervical ripening by misoprostol (a synthetic analog of prostaglandin E1), has been widely used to treat gynecological diseases, including submucosal myoma, endometrial polyps, and uterine synechia in nonpregnant women. The route of administration of misoprostol for cervical dilatation can be oral, vaginal, or sublingual. Aims The aim of the present study was to evaluate the efficacy of 400 μg misoprostol administered orally, vaginally, or sublingually on cervical ripening before hysteroscopy Patients and methods Study setting: Sayed Galal Hospital. Study duration: April 2017–April 2018. Number of patients: 300 patients. A prospective randomized controlled single-blinded trial. Nonpregnant women scheduled for hysteroscopy were divided randomly into four groups using sealed opaque envelopes to receive 400 mg of misoprostol, administered either orally (n=75) or vaginally (n=75) 6–8 h prior to surgery or 400 mg sublingually (n=75) 2–4 h prior to surgery or the control group (n=75) that received nothing. The primary outcome in this study was the preoperative cervical width as measured by the largest number of Hegar dilators. Duration of cervical dilatation was also recorded along with side effects related to misoprostol and complications during surgery for each group. Results The mean±SD cervical widths for oral, sublingual, vaginal, and control groups were 7.60±1.76, 7.56±1.64, 7.57±2.06, and 5.65±2.17 mm, respectively, which was statistically significant. Time to cervical dilatation was also significantly longer in the control group than in the other three groups. Misoprostol-related adverse effects and hysteroscopy-related complications were comparable among the four study groups. Conclusion All routes (oral, sublingual, vaginal) of administrations of misoprostol are equally effective in inducing proper cervical priming before hysteroscopy.


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