Cervical ripening before operative hysteroscopy in premenopausal women: a randomized, double-blind, placebo-controlled comparison of vaginal and oral misoprostol.
OBJECTIVE
To compare the effectiveness of oral and vaginal misoprostol for preoperative cervical ripening in premenopausal women before hysteroscopic surgery.


METHODS
Placebo-controlled, double blind, randomized trial.


METHODS
University hospital.


METHODS
Eighty-six premenopausal women eligible for operative hysteroscopy were recruited. Nine women were excluded from the study.


METHODS
Patients were randomly assigned to receive 400 microg of misoprostol orally (n = 39) or vaginally (n = 38), 10-12 hours before operative hysteroscopy.


METHODS
Extent of initial cervical width, percentage of patients requiring cervical dilatation, duration of cervical dilatation and surgical procedure, complications during procedure, and associated side effects.


RESULTS
Mean cervical widths in the vaginal and oral misoprostol groups after treatment were 7.3 +/- 1.6 mm and 6.0 +/- 1.5 mm, respectively, which was a statistically significant difference. Time required for cervical dilatation (98.6 +/- 88.7 s vs. 49.1 +/- 34.9 s) and duration of surgery (14.5 +/- 6 vs. 7.7 +/- 4.0 min) was statistically significantly shorter in the vaginal misoprostol group. The percentage of women with an initial cervical width of 9 mm was statistically significantly higher in the vaginal misoprostol group (36.8% vs. 5.1%). Uterine perforation occurred in two patients in the oral misoprostol group and in none in the vaginal misoprostol group. Side effects were comparable between the two treatment groups.


CONCLUSIONS
Vaginal administration of misoprostol is more effective than the oral route for preoperative cervical ripening in premenopausal women.
Batukan
Cem
C
Department of Obstetrics and Gynecology, School of Medicine, Erciyes University, Kayseri, Turkey. cbatukan@erciyes.edu.tr
Ozgun
Mahmut T
MT
Ozcelik
Bulent
B
Aygen
Ercan
E
Sahin
Yilmaz
Y
Turkyilmaz
Cagdas
C
D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects; D007747:Labor Stage, First / Q000187:drug effects*; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D017697:Premenopause; D011300:Preoperative Care; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014595:Uterine Perforation / Q000209:etiology; D014599:Uterus / Q000187:drug effects* / Q000473:pathology / Q000601:surgery
D010120:Oxytocics; D016595:Misoprostol