Vaginal misoprostol for cervical dilatation before operative office hysteroscopy

Abstract

Objective To assess the efficacy of misoprostol as an adjunct for easy cervical dilatation before operative office hysteroscopy under local anaesthesia. Design Randomized, placebo‐controlled clinical trial. Setting Tertiary centre for treatment of infertility. Subjects Patients undergoing hysteroscopy, for simultaneous diagnostic and operative indications such as uterine septae, synechiae, submucous myomas, endometrial polyps and lost intrauterine devices, were included into the study Intervention 43 cases were randomized to misoprostol (n=22) and placebo (n=21) groups. The drug was administered vaginally 4 h before hysteroscopy. Hysteroscopy was performed under local anaesthesia in an examination room as an office procedure. Main outcome measures Rapid and easy dilatation, decreased pain, decreased incidence of cervical haemorrhage, laceration and uterine perforation. Results In the misoprostol group, a 7‐mm hysteroscopic sheath passed easily without dilatation in 20 (91%) cases while it passed easily without dilatation in six (28%) of the placebo group (P<0.001). The average dilatation time for groups was 1.6 and 2.8 minutes respectively (P<0.05). Mean dilatation pain scores for the misoprostol and placebo groups were 5.1 and 9.3, respectively (P<0.05). Cervical bleeding was noted in two cases in the misoprostol group and laceration of the cervix was noted in three cases. In the placebo group there were eight cases each of both bleeding and laceration. Conclusion Application of misoprostol does provide a safe, painless and effective means of cervical dilatation by chemical, rather than mechanical forces, and reduces complications such as cervical bleeding, laceration and uterine perforation.