A randomized comparison of vaginal misoprostol and dinoprostone for cervical priming in nulliparous women before operative hysteroscopy.
OBJECTIVE
To compare the efficacy and side effects of vaginal misoprostol with dinoprostone for cervical priming before operative hysteroscopy and to assess the cervicouterine complications related to cervical dilatation and hysteroscopic surgery.


METHODS
A prospective randomized study.


METHODS
Tertiary university hospital.


METHODS
Three hundred ten nulliparous women with definite intrauterine lesions.


METHODS
Hysteroscopic surgery of intrauterine lesions.


METHODS
Cervical response, outcome, complications of hysteroscopic surgery, and side effects of both drugs.


RESULTS
Among the 310 patients recruited, 152 were randomized to the vaginal misoprostol group and 158 to the dinoprostone group. Mean cervical dilatation, cervical dilatation rate, and mean time for cervical dilatation to Hegar 9 were significantly different between the misoprostol group (7.4 +/- 0.8 mm, 70.4%, and 39.5 +/- 18.8 seconds, respectively) and the dinoprostone group (7.0 +/- 0.9 mm, 80.4%, and 43.6 +/- 17.1 seconds, respectively). Cervical tearing during hysteroscopic surgery occurred in 3 patients (2.0%) in the misoprostol group and in 12 patients (7.6%) in the dinoprostone group. There were more side effects in the misoprostol group. The significant difference of side effects between the two groups were abdominal pain, vaginal bleeding, and feeling feverish, which occurred in 36.2%, 29.6%, and 7.2% in the misoprostol group compared to 21.5%, 16.5%, and 1.3%, respectively, in the dinoprostone group.


CONCLUSIONS
Vaginal misoprostol is more effective than dinoprostone for cervical priming in nulliparous women before hysteroscopic surgery. Although more side effects occurred in the misoprostol-treated patients, they were mild. We suggest using vagina misoprostol for cervical priming instead of dinoprostone.
Preutthipan
Sangchai
S
Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. raspt@mahidol.ac.th
Herabutya
Yongyoth
Y
D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000187:drug effects*; D015232:Dinoprostone / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects; D010298:Parity; D011247:Pregnancy; D011292:Premedication / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D016896:Treatment Outcome
D010120:Oxytocics; D016595:Misoprostol; D015232:Dinoprostone