title: Intracervical versus vaginal misoprostol for cervical dilatation prior to operative hysteroscopy-a comparative study.
abstract: BACKGROUND
  Hysteroscopic surgery requires pre-operative cervical ripening to facilitate adequate dilatation of the cervix for insertion of operative hysteroscope. This study was conducted to compare the efficacy of intracervical misoprostol with vaginal misoprostol in achieving cervical ripening before operative hysteroscopy.
  
  
  METHODS
  In this randomised comparative study conducted at a tertiary care teaching hospital, 56 patients needing operative hysteroscopy were divided into two groups of 28 patients, one for intracervical misoprostol and the other for vaginal misoprostol. Four hundred microgram of misoprostol was inserted on the night before and in the morning of operative hysteroscopy intracervically in group I and vaginally in group II.
  
  
  RESULTS
  Primary outcome measure was number of patients achieving 7 mm preoperative dilatation of cervix. Largest Hegar dilator that could be passed into the uterine cavity past the internal optic sheath without resistance was noted in each case. Mean cervical dilatation prior to operative hysteroscopy was calculated. In addition, incidence of slipping of vulsellum and cervical laceration was also noted. Time to achieve full cervical dilatation was recorded. In 23/28 cases of group I and 5/28 in group II, size 7 Hegar dilator could be passed without effort. Mean cervical dilatation was 7.5 mm in group I and 5.7 mm in group II. Slipping of the vulsellum and cervical lacerations were seen in significantly less patients in group I. Mean time to achieve cervical dilatation to 10 mm was 43.39 seconds in group I and 103.96 seconds in group II (P<0.0001).
  
  
  CONCLUSIONS
  Intracervical administration of misoprostol is an effective method of achieving cervical ripening for easy cervical dilatation up to 10 mm prior to operative hysteroscopy.
authors.affiliation: Senior Advisor, Kolkata - 700027.
authors.forename: Bk
authors.initials: B
authors.lastname: Goyal
authors.affiliation: Resident, Kolkata - 700027.
authors.forename: Premansu
authors.initials: P
authors.lastname: Roy
authors.affiliation: Classified Specialist (Obstetrics & Gynaecology), Command Hospital (EC), Kolkata - 700027.
authors.forename: Pm
authors.initials: P
authors.lastname: Bhat
authors.affiliation: Senior Advisor, Kolkata - 700027.
authors.forename: Nk
authors.initials: N
authors.lastname: Das
authors.affiliation: Senior Advisor, Kolkata - 700027.
authors.forename: Kg
authors.initials: K
authors.lastname: Paul
authors.affiliation: Senior Advisor (Obstetrics & Gynaecology), Army Hospital (R&R), Delhi Cantt. - 110010.
authors.forename: Bs
authors.initials: B
authors.lastname: Duggal
keywords: cervical ripening; intracervical administration; misoprostol; operative hysteroscopy