Comparison of Effectiveness of Laminaria versus Vaginal Misoprostol for Cervical Preparation Before Operative Hysteroscopy in Women of Reproductive Age: A Prospective Randomized Trial.
OBJECTIVE
To compare the effectiveness and safety of intracervical laminaria dilator versus intravaginal misoprostol administered before surgery to facilitate cervical dilation before operative hysteroscopy.


METHODS
A prospective randomized study (Canadian Task Force classification 1).


METHODS
A university hospital.


METHODS
A total of 150 women were assigned at random to the following groups: laminaria dilation (n = 50), misoprostol dilation (n = 50), and mechanical dilation (n = 50).


METHODS
Hysteroscopic surgery of intrauterine lesions.


RESULTS
In this study, 150 women were assigned at random to receive cervical priming with an intracervical laminaria dilator, 200 μg of intravaginal misoprostol, or a mechanical dilator before operative hysteroscopy. Cervical response, surgical outcome, and complications of operative hysteroscopy were assessed. Visual analog scale (VAS) pain scores were recorded in the misoprostol and laminaria dilation groups. Demographic variables of the study groups were comparable (p = .278-.988). The duration of cervical pretreatment was similar with the intracervical laminaria dilator and intravaginal misoprostol (p = .803); however, intravaginal misoprostol was associated with more adverse effects (p = .031). Compared with the misoprostol dilation group, in which all patients required additional cervical dilation, notably fewer patients in the laminaria dilation group required additional cervical dilation after cervical preparation (p = .001). VAS pain scores were significantly higher in the laminaria dilation group, however (p = .001).


CONCLUSIONS
Cervical priming with an intracervical laminaria dilator before operative hysteroscopy reduces the need for cervical dilation and better facilitates hysteroscopic surgery compared with intravaginal misoprostol. Oral analgesic use may be required before the use of this device.
Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey. Electronic address: karakussavas@yahoo.com.
Savas
S
Karakus
Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey.
Ozlem Bozoklu
OB
Akkar
Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey.
Caglar
C
Yildiz
Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey.
Gonca Imir
GI
Yenicesu
Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey.
Meral
M
Cetin
Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey.
Ali
A
Cetin
D000282:Administration, Intravaginal; D000328:Adult; D000700:Analgesics; D002584:Cervix Uteri / Q000187:drug effects* / Q000601:surgery; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods*; D007795:Laminaria; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D010147:Pain Measurement; D011247:Pregnancy; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000601:surgery; D014591:Uterine Diseases / Q000601:surgery*
D000700:Analgesics; D010120:Oxytocics; D016595:Misoprostol
Cervical dilation; Laminaria dilator; Mechanical dilation; Misoprostol; Operative hysteroscopy