title: Optimal timing of misoprostol administration in nulliparous women undergoing office hysteroscopy: a randomized double-blind placebo-controlled study.
abstract: To determine the optimal timing of vaginal misoprostol administration in nulliparous women undergoing office hysteroscopy.
  
  
  
  Randomized double-blind placebo-controlled study.
  
  
  
  University teaching hospital.
  
  
  
  One hundred twenty nulliparous patients were randomly allocated in a 1:1 ratio to the long-interval misoprostol group or the short-interval misoprostol group.
  
  
  
  In the long-interval misoprostol group, two misoprostol tablets (400 μg) and two placebo tablets were administered vaginally at 12 and 3 hours, respectively, before office hysteroscopy. In the short-interval misoprostol group, two placebo tablets and two misoprostol tablets (400 μg) were administered vaginally 12 and 3 hours, respectively, before office hysteroscopy.
  
  
  
  The severity of pain was assessed by the patients with the use of a 100-mm visual analog scale (VAS). The operators assessed the ease of the passage of the hysteroscope through the cervical canal with the use of a 100-mm VAS as well.
  
  
  
  Pain scores during the procedure were significantly lower in the long-interval misoprostol group (37.98 ± 13.13 vs. 51.98 ± 20.68). In contrast, the pain scores 30 minutes after the procedure were similar between the two groups (11.92 ± 7.22 vs. 13.3 ± 6.73). Moreover, the passage of the hysteroscope through the cervical canal was easier in the long-interval misoprostol group (48.9 ± 17.79 vs. 58.28 ± 21.85).
  
  
  
  Vaginal misoprostol administration 12 hours before office hysteroscopy was more effective than vaginal misoprostol administration 3 hours before office hysteroscopy in relieving pain experienced by nulliparous patients undergoing office hysteroscopy.
  
  
  
  NCT02316301.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address: umfrfouda@yahoo.com.
authors.forename: Usama M
authors.initials: UM
authors.lastname: Fouda
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Sherine H
authors.initials: SH
authors.lastname: Gad Allah
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Hesham S
authors.initials: HS
authors.lastname: Elshaer
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D000553:Ambulatory Care; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004534:Egypt; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D009819:Office Visits; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010298:Parity; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol
keywords: Pain; misoprostol; office hysteroscopy