Misoprostol for cervical ripening prior to gynecological transcervical procedures

Abstract

Dilatation and curettage is frequently performed in gynecological practice. Aim of this prospective randomized double-blind placebo-controlled study was to evaluate the safety and efficacy of oral misoprostol to prime non-pregnant cervix before this procedure. Women requiring dilatation and curettage were included in the study. Exclusion criteria were visible growth in cervix or vagina, pregnancy, allergy to prostaglandins, some medical disorders. Each participant was instructed to take either 400µg of misoprostol or placebo orally 12h before the procedure. Primary outcome measure was: diameter of the largest negotiable Hegar's dilator through internal os without any resistance at the beginning of the procedure. Secondary outcome measures were: percentage of women with initial cervical dilatation of ≥5mm, time required for optimum cervical dilatation, percentage of failed procedures and complications. t test, Chi-square test and Fisher's test were used to compare the variables. Misoprostol significantly increased baseline cervical diameter in the pre-menopausal group (p<0.001), but not in post-menopausal subjects (p=0.1) and reduced time required for cervical dilatation in both pre-and post-menopausal women. The number of patients achieving initial cervical dilatation ≥5 mm was significantly greater in pre-menopausal subjects receiving misoprostol, but not significant in post-menopausal ones. The drug was also found to be effective in both nulliparous and multiparous patients. Side effects were comparable between two groups. Only nausea and vomiting were more frequent in post-menopausal misoprostol group than placebo (p=0.018). Four hundred micrograms of oral misoprostol 12h prior to dilation and curettage was found to be beneficial in cervical priming in pre-menopausal subjects. It was also found to be effective irrespective of the parity of the patients.