title: Vaginal Misoprostol for Cervical Priming before Gynaecological Procedures on Non Pregnant Women.
abstract: BACKGROUND
  Misoprostol has been extensively researched for its use in obstetrics and has proved to be a very effective cervical softening agent before termination of pregnancy. The beneficial effects on cervical ripening may make misoprostol a desirable agent for helping cervical dilatation on non pregnant women also. The objective is to study the efficacy of preoperative vaginal application of misoprostol as cervical priming agent before gynaecological procedures on non pregnant women.
  
  
  METHODS
  
  
  
  METHODS
  A randomized controlled trial.
  
  
  METHODS
  Department of Gynaecology and Obstetrics of two medical colleges.
  
  
  METHODS
  468 non pregnant pre-menopausal nulli-parous or parous women scheduled to have diagnostic D&C or diagnostic hysteroscopy operations.
  
  
  METHODS
  400 mcg intravaginal misoprostol (229 women) in the study group and 400 mg intravaginal metronidazole as placebo (231 women) in control group.
  
  
  METHODS
  The main outcome measures were baseline cervical width at the beginning of the procedures, the number of women who required further cervical dilatation, time taken for dilatation, side effects and other complications.
  
  
  RESULTS
  Base line cervical width in the study group was significantly higher than control group (4.6±0.8 mm vs. 3.8±0.7 mm, p < 0.0001). 141 (61.57%) cases required further cervical dilatation in the study group compared to 206 (89.18%) in the control group (p < 0.0001). Time taken for further cervical dilatation was significantly lower in the study group compared to control group (48.3±18.4 sec vs. 68.6±17.3 sec, p < 0.0001). Cervical injury and uterine perforation occurred in 12 and 3 women respectively in the control group compared to 1 and 0 women respectively in the misoprostol group. Two most common side effects of vaginal misoprostol were mild lower abdominal pain (21%) and slight vaginal bleeding (09.2%) which were within tolerable limit.
  
  
  CONCLUSIONS
  Preoperative vaginal application of misoprostol before gynaecological procedures on non pregnant women decreases the cervical resistance, facilitates the cervical dilatation and operative procedures minimizing cervical or uterine injuries.
authors.affiliation: Deptt. of Obst. & Gyne, North Bengal Medical College, Darjeeling, West Bengal.
authors.forename: Shyama Prasad
authors.initials: SP
authors.lastname: Saha
authors.forename: Nabendu
authors.initials: N
authors.lastname: Bhattacharjee
authors.forename: Gangotri
authors.initials: G
authors.lastname: Baru