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 (400μg) and two placebo tablets were administered vaginally at 12 and 3hours, respectively, before office hysteroscopy. In the short-interval misoprostol group, two placebo tablets and two misoprostol tablets (400μg) were administered vaginally 12 and 3hours, 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 30minutes 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 12hours before office hysteroscopy was more effective than vaginal misoprostol administration 3hours before office hysteroscopy in relieving pain experienced by nulliparous patients undergoing office hysteroscopy. NCT02316301.