Comparative study of the effectiveness of two different dosage of sublingual misoprostal for cervical ripening before hysteroscopy

Background: Hysteroscopy a minimally invasive approach for evaluating uterine cavity, and has become an indispensable diagnostic and therapeutic procedure. The main limiting factor while performing office hysteroscopy is the level of pain or discomfort encountered during the procedure. The pain is attributed mainly to the difficulty in entering the internal cervical os with the hysteroscope and while distending uterine cavity. It could be reduced if cervix is ripened before the procedure. The purpose of this prospective observational study was to compare the effectiveness, adverse effects and surgery-related complications associated with two different doses of sublingual Misoprostol (100 and 200 µg) given 2-4 hours before hysteroscopy.Methods: A randomised comparative study was conducted in the department of Obstetrics and Gynaecology of ABVIMS and Dr. RML hospital New Delhi, from 1st November, 2018 to 31st March, 2020. One hundred and twenty women, fulfilling inclusion criteria were subjected to hysteroscopy. Women received either 100 µg (Group I) or 200 µg (Group II) of sublingual Misoprostol 2-4 hours prior to hysteroscopy. The primary outcome of the study was cervical dilatation as measured by the largest number of Hegar dilator that could be inserted without resistance at the beginning of procedure. The largest dilator that negotiated cervical canal without resistance at the beginning of procedure was recorded as the baseline cervical width. The secondary outcomes were subjective assessment of the surgeon of the ease of dilatation of cervix and adverse effects of drug (i.e. vaginal bleeding, shivering, fever and pain as measured on visual analog scale).Results: The mean baseline cervical width as measured by first Hegar dilator that could be passed through the cervical canal without resistance was 6.6±0.62 mm in group I and 6.94±1.21 mm in group II respectively                    (p value=0.016). Adverse effects like vaginal bleeding, shivering was more in group II compared to group I. No statistically significant difference was found between group I and II with regards to visual analog scale.Conclusions: 100 µg Misoprostol can be used for cervical ripening prior to hysteroscopy with minimal adverse effects

Misoprostol's preoperative cervical ripening effect

Prostaglandins are recommended for preoperative cervical ripening before surgical abortion, although the ideal dose, route and timing for misoprostol is debated. Prostaglandins appear to be effective for cervical ripening in nonpregnant women although few trials with the power to evaluate primary efficacy outcome levels have been conducted. The ideal misoprostol dose, route and timing for cervical ripening before hysteroscopy in premenopausal women has not been established. WHAT THIS STUDY ADDS Four hundred micrograms oral misoprostol before surgical abortion has a similar cervical ripening effect but a higher rate of side effects, compared with two hundred micrograms self-administered vaginal misoprostol. One thousand micrograms vaginal misoprostol is effective for cervical ripening in premenopausal, but not postmenopausal women before hysteroscopy. After 14 days of local estradiol therapy, postmenopausal women also achieve a cervical ripening effect with one thousand micrograms vaginal misoprostol. Self-administered vaginal misoprostol is a highly acceptable, practical and inexpensive method to achieve preoperative cervical ripening

Uso del misoprostol en Obstetricia y Ginecología

101 p.Para la Federación Latinoamericana de Obstetricia y Ginecología – FLASOG, es preocupante el incremento de las tasas de morbi-mortalidad materna en nuestros países y, en particular, las complicaciones derivadas de la atención profesional a la mujer gestante y su impacto negativo sobre las posibilidades de acceso a los servicios de atención en salud de mediana y alta complejidad, principalmente aquellas provenientes de las comunidades más vulnerables donde los servicios esenciales como la salud pública integral se ven limitados en muchos escenarios en relación a la atención ginecológica y obstétrica. Con este panorama y preocupados por la situación epidemiológica de la región, FLASOG se permite actualizar y articular las mejores experiencias clínicas y de investigación en el desarrollo de esta nueva edición del Manual de uso de misoprostol en Obstetricia y Ginecología - 2013, la cual se espera contribuya notoriamente a las mejores prácticas clínicas en beneficio de nuestras mujeres latinoamericanas.Fil: Garello, Néstor César. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. II Cátedra de Clínica Ginecológica; Argentina.Fil: De Melo, Nilson Roberto. Federación Latinoamericana de Sociedades de Obstetricia y Ginecología; Brasil.Fil: Gómez Sánchez, Pío Iván. Federación Latinoamericana de Sociedades de Obstetricia y Ginecología; Colombia