Vaginal Misoprostol For Cervical Priming Research Articles

A randomised comparative study of sublingual and vaginal misoprostol for cervical priming before minor gynaecological procedures

This study aimed to compare the effect of misoprostol using vaginal or sublingual routes on the non-pregnant uterine cervix prior to minor gynaecological procedures. One hundred and forty women were randomised 1:1 into two groups: A and B. Group A received misoprostol 400 mcg vaginally and pyridoxine 40 mg sublingually and Group B received misoprostol 400 mcg sublingually and pyridoxine 40 mg vaginally 4 h prior to procedure. The outcomes studied were maximum size of Hegar’s dilator that could be inserted into the cervix without any resistance, ease of dilatation, need and time required for further dilatation, side effects and complications. Baseline cervical dilatation was significantly more in Group A than Group B. Need for further dilatation and time required for further dilatation were also significantly less in Group A than Group B. Thus, we conclude that vaginal misoprostol is more effective than sublingual misoprostol in cervical priming before minor gynaecological procedures. Clinical Trial Registration Number: www.ctri.nic.in; CTRI/2018/07/015080 IMPACT STATEMENT What is already known on this subject? Cervical priming has been shown to result in shorter operative time, easier mechanical dilatation, reduced incidence of complications and blood loss when used prior to surgical abortion and has been recommended as a standard practice in various national and international guidelines for safe abortion practices. Misoprostol has many advantages over other ripening agents like osmotic dilators, other prostaglandins and mifepristone. Misoprostol can be given through oral, sublingual, vaginal, buccal and rectal routes. Use of misoprostol has been found to improve cervical dilatation, reduce need of further dilatation and ease of dilatation without many complications when compared to placebo for cervical priming of non-pregnant cervix. Studies comparing vaginal and sublingual routes have shown no significant difference for cervical ripening in pregnant women. What the results of this study add? We found that vaginal misoprostol for cervical priming was more effective than sublingual misoprostol in reaching a higher baseline cervical dilatation, with reduced need and time required for further dilatation before minor gynaecological procedures, although the ease of dilatation was similar in both groups. This effect of vaginal misoprostol was more marked in premenopausal women. What the implications are of these findings for clinical practice and/or further research? The results of our study are at variance with other studies done on use of misoprostol via the vaginal or sublingual routes, and hence it is imperative that large multi-center studies be performed to bring about consensus on the topic.

Potency and acceptability of oral misoprostol compared with vaginal misoprostol prior to first trimester abortions

Present study was done to assess the effectiveness and acceptability of oral misoprostol compared with vaginal misoprostol for cervical priming before termination of first trimester pregnancy. Recently, prostaglandin E1 analogue misoprostol has caught much attention as cervical priming agent. Prostaglandins are used in different doses and different routes considering the different available results. Misoprostol was originally marketed for prevention of peptic ulcers caused by Prostaglandin synthetase inhibitor (NSAIDS) but now it has a widespread role in obstetric practice specially as a cervical priming agent. The aim of present study is to compare oral misoprostol versus vaginal misoprostol for cervical ripening and to assess its acceptability among women.

To study the efficacy of vaginal misoprostol for cervical priming in first trimester MTP

To study the efficacy of vaginal misoprostol for cervical priming in first trimester MTP

Vaginal Misoprostol for Cervical Priming Before Outpatient Hysteroscopy: A Randomized Controlled Trial

Background: Misoprostol has generally shown good efficacy in promoting cervical softness and facilitating hysteroscopic procedures. Objective: To evaluate the efficacy and safety of vaginal misoprostol for cervical priming before diagnostic outpatient hysteroscopy (OH) without anesthesia. Patients and Methods: Design: Double-blind randomized controlled trial. Setting: University teaching hospital. Patient(s): Ninety patients requiring diagnostic OH for investigation of infertility or abnormal uterine bleeding in the reproductive age. Intervention(s): Patients were randomly allocated into two equal groups (n= 45). In group I, 200 mcg misoprostol was inserted into the posterior vaginal fornix 3 hours before OH; in group II (control), 250 mg metronidazole as placebo was inserted into the posterior vaginal fornix by investigator. A rigid 30 4-mm hysteroscope was used in the vaginoscopic technique. Main Outcome Measure(s): Ease of cervical entry (Likert scale), procedural time, patient acceptability (Likert scale), and pain scoring (visual analog scale). Result(s): Vaginal misoprostol significantly facilitated the procedure; cervical entry was easier, procedural time was shorter, patient acceptability was higher, and pain scoring was lower in group I compared with group II. Side effects of misoprostol were infrequent, minor, and transient. No complications were reported. Conclusion(s): The regimen of 200 mcg vaginal misoprostol administered 3 hours before diagnostic OH is a simple, effective, and safe method of cervical priming to facilitate the procedure without anesthesia.

Vaginal Misoprostol for Cervical Priming Before Outpatient Hysteroscopy: A Randomized Controlled Trial

Vaginal Misoprostol for Cervical Priming Before Outpatient Hysteroscopy: A Randomized Controlled Trial

English

OBJECTIVE: To evaluate the effectiveness of vaginal misoprostol for cervical priming before Diagnostic hysteroscopy in perimenopausal women. MATERIALS AND METHODS: Sixty women scheduled for hysteroscopy were randomly assigned to 2 groups. The study group (n = 30) received 400 µg of vaginal misoprostol 12 h before the procedure and the control group (n=30) without any drugs. The aim of study was to know the primary outcome i.e. the number of women who required cervical dilatation. Secondary outcome was cervical width (the largest size of Hegar dilator inserted without resistance as well as complications and adverse effects. RESULTS: Majority 26 (86.6%) of women didn't required cervical dilatation in misoprostol group as compared to 4 (13.4%) of women who required cervical dilatation in same group. However, majority 27(90%) of women required dilatation in control group. The association was highly significant statistically (x2 = 20.314 P < 0.0001).The largest size of Hegar dilator inserted without resistance was 8.0±0.5 mm in misoprostol group Vs. 5.5± 1.2 mm in the control group (p<0.0001).The results were statistically significant. Uterine perforation occurred in 1 woman (3.3%) in the control group and none in misoprostol group. 9 women (30%) experienced mild side effects like lower abdominal pain, fever and vaginal spotting after misoprostol application. CONCLUSIONS: We come to the conclusion by our study that the use of vaginal misoprostol is an effective cervical priming agent prior to Diagnostic hysteroscopy in perimenopausal women with minimal side effects. Misoprostol is a drug with low cost, easy application and is very useful for cervical priming.

Cervical Priming Before Diagnostic Operative Hysteroscopy in Infertile Women: A Randomized, Double-Blind, Controlled Comparison of 2 Vaginal Misoprostol Doses

The aim of this study was to evaluate the efficacy of vaginal misoprostol for cervical priming at doses of 200 mcg and 400 mcg, 12 to 15 hours before diagnostic office hysteroscopy (OH) without anesthesia in patients with infertility. Sixty infertile patients requiring a diagnostic office hysteroscopy for investigation of infertility were included in the study. The patients were randomly allocated into 3 vaginally administered misoprostol groups: (1) control group, (2) 200-mcg dose group, and (3) 400-mcg dose group. Misoprostol significantly facilitated the procedure of OH: cervical entry was easier; procedural time was shorter; baseline cervical width was larger; and pain scoring was lower in the misoprostol groups compared with the control group. Increasing the dose of misoprostol from 200 mcg to 400 mcg did not improve the effect on cervical dilation. Misoprostol is a promising analog to use for cervical priming before OH. Since doses of 200 mcg and 400 mcg vaginal misoprostol 12 hours before the OH both have proven to be effective regimens, 200 mcg may be preferred. However, before routine clinical usage, further research is needed through large, randomized, controlled trials powered to detect a difference in complications to determine whether misoprostol reduces complications in OH.

Vaginal misoprostol for cervical priming before dilation and curettage procedures on premenopausal and postmenopausal women

Evidence Based Women’s Health Journal 2013, 3:39–44 Introduction Misoprostol has been proved to be a very effective cervix softening agent before termination of pregnancy. This beneficial effect may make misoprostol a desirable agent for cervical dilatation in nonpregnant women. The aim of the study was to investigate the efficacy of preoperative vaginal application of misoprostol as a cervix priming agent before dilatation and curettage procedures in premenopausal and postmenopausal women. Methods A randomized controlled clinical trial was carried out among 200 women (100 premenopausal women and 100 postmenopausal women) who were divided into two treatment groups: one group was treated with misoprostol (the study group) and the other was treated with placebo (the control group). The study group received two tablets of 400mg misoprostol vaginally. The control group received two placebo tablets of 500 mg metronidazole vaginally. Main outcome measure Women were assessed at the beginning of the procedures for baseline cervical width, need for further cervical dilatation, duration of the procedure, complications during dilatation, and associated side effects were also recorded. Results The premenopausal and postmenopausal women who received misoprostol had higher baseline cervical dilatation compared with women in the placebo group (P = 0.001). In premenopausal women, the mean cervical dilatation was 6.1 mm ( ± 1.4) in the misoprostol group compared with 3.3 mm ( ± 1.1) in the placebo group. The misoprostol cervical ripening effect on postmenopausal women was 4.2 mm ( ± 0.9) compared with 3.1 mm ( ± 0.8) in the placebo group; hence, further cervical dilatation was required in women of the placebo group, with a statistically significant difference between premenopausal (P = 0.002) and postmenopausal women (P = 0.006). Misoprostol helped in reducing the time taken for dilatation, with a statistically significant difference between premenopausal (P = 0.001) and postmenopausal women; however, time was much shorter in premenopausal women (P = 0.01). Blood loss and degree of resistance were less evident with the use of misoprostol among premenopausal and postmenopausal women, without a statistically significant difference. There was no statistically significant difference with respect to the incidence of misoprostol-related adverse effects and complications. The majority (96% of premenopausal and 94% of postmenopausal women) found vaginal misoprostol to be acceptable. Conclusion Vaginal misoprostol has promising beneficial effects when used for cervical priming in premenopausal and postmenopausal women with tolerable minor side effects.

A double-blind randomized controlled trial of vaginal misoprostol for cervical priming before outpatient hysteroscopy

To evaluate the efficacy and safety of vaginal misoprostol for cervical priming before diagnostic outpatient hysteroscopy (OH) without anesthesia. Double-blind randomized controlled trial. University teaching hospital. One hundred fifty patients requiring diagnostic OH for investigation of infertility or abnormal uterine bleeding in the reproductive age. Patients were randomly allocated into two equal groups (n = 75). In group I, 200 μg misoprostol was inserted into the posterior vaginal fornix 3 hours before OH; in group II (control), vaginal examination was performed without misoprostol administration. A rigid 30° 4-mm hysteroscope was used in the vaginoscopic technique. Ease of cervical entry (Likert scale), procedural time, patient acceptability (Likert scale), and pain scoring (visual analog scale). Vaginal misoprostol significantly facilitated the procedure; cervical entry was easier, procedural time was shorter, patient acceptability was higher, and pain scoring was lower in group I compared with group II. Side effects of misoprostol were infrequent, minor, and transient. No complications were reported. The regimen of 200 μg vaginal misoprostol administered 3 hours before diagnostic OH is a simple, effective, and safe method of cervical priming to facilitate the procedure without anesthesia.

A randomized trial of vaginal misoprostol for cervical priming before hysteroscopy in postmenopausal women.

Objective:To perform hysteroscopy the cervix needs to be dilated and in nullipara and postmenopausal women this is sometimes difficult. Well-known, entry-related complications during hysteroscopy include cervical tear, creation of false tract, bleeding, uterine perforation, scarring, and subsequent anatomical stenosis.Materials and Methods:This study was done to investigate the priming effect of vaginal misoprostol on cervical dilatation in postmenopausal women, before hysteroscopy, to prevent such complications. Two hundred micrograms of misoprostol was inserted into the vagina at least 12 hours before the procedure and the control group did not receive any cervical priming agent. Pre-procedural dilatation, additional dilatation required, and time taken for dilatation was noted in each case.Observations:The study showed a significant difference between the study group (7.7 ± 1.7 mm) and the control group (4.5 ± 1.8 mm) in terms of pre-procedural cervical width and the number of women requiring a dditional dilatation (7 / 25 versus 22 / 25), and hence, the time required for dilatation (4.7 ± 8 seconds versus 20.6 ± 9.3 seconds).Conclusion:The pre-procedural cervical width was significantly more in the study group as compared to that in the control group. We found significant differences between the study and control groups with respect to the number of women who required cervical dilatation. To conclude, this study helps derive a conclusion that vaginal misoprostol as a cervical priming agent in postmenopausal women appears to be safe, effective, and inexpensive, with mild side effects.

Vaginal misoprostol for cervical priming before hysteroscopy in perimenopausal and postmenopausal women

Objective: To evaluate the effectiveness and possible adverse effects of vaginal misoprostol for cervical priming before hysteroscopy in perimenopausal and postmenopausal women. Methods: A total of 105 women scheduled for hysteroscopy were randomly assigned to 2 groups. The study group ( n = 51) received 400 μg of vaginal misoprostol at least 12 h before the procedure and the control group ( n = 54) received no cervical priming agent. The primary outcome measure was the number of women who required cervical dilation. Secondary outcomes were cervical width (the largest size of Hegar dilator inserted without resistance) as well as complications and adverse effects. Results: In the misoprostol group 27 women (52.9%) required cervical dilation vs. 53 (98.1%) in the control group ( P < 0.0001). The largest size of Hegar dilator inserted without resistance was 7.6 ± 1.4 mm in the misoprostol group vs. 5.0 ± 1.1 mm in the control group ( P < 0.0001). A similar effect of misoprostol on cervical dilation was also found in the subgroup of treated postmenopausal women. Only 2 women (3.9%) experienced mild lower abdominal pain after misoprostol application. Conclusion: Vaginal misoprostol applied before hysteroscopy reduced cervical resistance and the need for cervical dilation in perimenopausal and postmenopausal women, with only mild adverse effects.

A randomized comparison of sublingual and vaginal misoprostol for cervical priming before suction termination of first-trimester pregnancy

This randomized trial compares the efficacy and side effects of sublingual and vaginal misoprostol for cervical priming before first-trimester pregnancy termination. One-hundred pregnant women between 6 and 12 weeks of gestation opting for termination of pregnancy by suction evacuation were included in this study. The women were randomly allocated into two groups. Group 1 received 400 μg of sublingual misoprostol and group 2 received 400 μg of vaginal misoprostol 2 h prior to suction evacuation. The abortion was carried out by suction evacuation using a Karman's cannula attached to an electrically operated suction machine under intravenous analgesia. Baseline cervical dilatation, duration of the procedure, operative blood loss, side effects and complications were noted in both groups. There was a significant difference between the sublingual and vaginal misoprostol groups with respect to mean cervical dilatation (8.6 mm vs. 6.8 mm, p < 0.05). However, the duration of the procedure (3.03 min vs. 3.16 min) and the amount of blood loss (29 mL vs. 31.2 mL) were not significantly different between the two groups. The women in the sublingual group experienced significantly more shivering and preoperative vaginal bleeding (68% vs. 56%, p < 0.05). None of the women in the two groups had either uterine perforation or excessive hemorrhage. In our study, sublingual misoprostol (400 μg) was significantly more effective in facilitating cervical dilation prior to surgical abortion than vaginal misoprostol.

A randomized controlled trial of vaginal misoprostol for cervical priming before hysteroscopy

Objective: To evaluate the effectiveness and side effects of vaginal misoprostol for cervical dilation in nonpregnant women before hysteroscopy. Methods: Ninety-one women scheduled to have hysteroscopy were randomized to receive either vaginal misoprostol or placebo. Cervical response, outcome of hysteroscopy, and side effects of vaginal misoprostol were assessed. Results: The mean cervical dilatation estimated by Hegar dilator and the mean duration of hysteroscopy were significantly different between the treated group (7.0 ± 1.0 mm [range 6–8.5] and 90.0 ± 38.4 seconds [range 60–240], respectively) and the control group (3.8 ± 1.2 mm [range 2–5.5] and 142.0 ± 38.7 seconds [range 60–270]). In the misoprostol group, only three women (6.5%) needed cervical dilation before hysteroscopy, compared with 14 (31.1%) in the placebo group ( P = .006). Cervical tears during hysteroscopy occurred in two patients (4.4%) in the control group and none in the misoprostol group. The two most common side effects of vaginal misoprostol were mild lower abdominal pain in 15 women (32.6%) and slight vaginal bleeding in 12 (26.1%). Both side effects were significantly different when compared with placebo ( P < .001). Conclusion: Vaginal misoprostol lessens the cervical resistance in women undergoing hysteroscopy and facilitates the procedure, with only mild side effects.

A randomised placebo-controlled trial of vaginal misoprostol for cervical priming before hysteroscopy in postmenopausal women

Objective To investigate the effectiveness of misoprostol given vaginally for cervical priming before hysteroscopy in postmenopausal women. Design Double-blind randomised controlled study. Setting Regional hospital, Hong Kong. Participants One hundred women with postmenopausal bleeding scheduled for hysteroscopy from October 1998 to September 2001 were randomly assigned to receive either misoprostol or placebo vaginally before the operation. Main outcome measures The number of women requiring cervical dilatation, outcome of hysteroscopy and side effects of the medication were assessed. Results Forty-eight women receiving misoprostol and 48 women receiving placebo were compared. The mean degree of endocervical diameter estimated by Hegar's dilator was similar between the treatment group and the control group. A similar number of women in the treatment group and the control group required cervical dilatation. The operative times for both groups were similar. The incidence of side effects was comparable in both groups. The most common side effects for misoprostol were febrile episodes and diarrhoea. There was no cervical tear nor uterine perforation encountered in both groups. The mean duration of hospital stay in both groups were similar. Subanalysis of results were similar in women receiving vaginal medication at least five hours before the operation. Conclusion Vaginal misoprostol was not shown to reduce the need for cervical dilatation in postmenopausal women. It cannot convert diagnostic hysteroscopy from a hospital procedure into an office one in postmenopausal women with tight cervical os.

Oral versus vaginal misoprostol for cervical priming in first-trimester abortion: a randomized trial

The objective of this study was to compare the oral and vaginal administration of misoprostol for cervical priming before surgical abortion up to 63 days' gestation. A total of 900 pregnant women, with ages ranging from 18 to 42 years, who asked for pregnancy termination, were included in this study. Women were randomly allocated to one of the following groups: oral administration of 400 μg misoprostol, 8 h before aspiration; and vaginal self-administration of 400 μg misoprostol, 4 h before aspiration. During admission, all subjects were checked on a 15-min basis. The preoperative cervical dilatation achieved was the main outcome assessed. The cervix was dilated (Hegar ≥ 8) in 348 (78%) subjects from the oral treatment group and in 391 (87%) women from the vaginal treatment group; this difference was statistically significant (p = 0.0004). The mean dilatation achieved in the oral treatment group was 8.1 mm (SD 1.6 mm) and it was 8.5 mm (SD 1.5 mm) in the vaginal treatment group; this difference was statistically significant (p = 0.0001). The frequencies of side-effects such as nausea, vomiting, diarrhea and chills reported by women from the vaginal misoprostol group were 10, 8, 18 and 4 times lower, respectively, than those reported by subjects from the oral misoprostol group. In conclusion, vaginal self-administration of misoprostol was the best administration route, as it obtained the same or greater priming effectiveness of the cervix in half the time with a much lower frequency of side-effects.

Oral versus vaginal misoprostol for cervical priming in first-trimester abortion: a randomized trial

The objective of this study was to compare the oral and vaginal administration of misoprostol for cervical priming before surgical abortion up to 63 days' gestation. A total of 900 pregnant women, withages ranging from 18 to 42 years, who asked for pregnancy termination, were included in this study. Women were randomly allocated to one of the following groups: oral administration of 400 μg misoprostol,8 h before aspiration; and vaginal self-administration of 400 μg misoprostol, 4 h before aspiration. During admission, all subjects were checked on a 15-min basis. The preoperative cervical dilatationachieved was the main outcome assessed. The cervix was dilated (Hegar ≥ 8) in 348 (78%) subjects from the oral treatment group and in 391 (87%) women from the vaginal treatment group; this differencewas statistically significant (p = 0.0004). The mean dilatation achieved in the oral treatment group was 8.1 mm (SD 1.6 mm) and it was 8.5 mm (SD 1.5 mm) in the vaginal treatment group; this differencewas statistically significant (p = 0.0001). The frequencies of side-effects such as nausea, vomiting, diarrhea and chills reported by women from the vaginal misoprostol group were 10, 8, 18 and 4times lower, respectively, than those reported by subjects from the oral misoprostol group. In conclusion, vaginal self-administration of misoprostol was the best administration route, as it obtained thesame or greater priming effectiveness of the cervix in half the time with a much lower frequency of side-effects.

Vaginal Misoprostol for Cervical Priming Before Operative Hysteroscopy

In Brief Objective To investigate the effectiveness of vaginal misoprostol for cervical priming before operative hysteroscopy and to assess the cervicouterine complications related to cervical dilatation and hysteroscopic surgery in nulliparous women. Methods One hundred fifty-two women with definite intrauterine lesions were randomly assigned to receive either 200 μg vaginal misoprostol or placebo. Cervical response and outcome and complications of operative hysteroscopy were assessed. Results Thirty-five subjects were needed in each arm to detect a type I error of 0.01 with a power of 0.99. The mean cervical dilatation estimated by Hegar dilator was significantly different between the treated group (7.3 ± 0.7 mm) and the control group (3.8 ± 1.1 mm, P < .001). In the misoprostol group, 55 (75.3%) patients needed cervical dilation, compared with 75 (94.9%, P = .001) in the placebo group. The median time of cervical dilation to Hegar number 9 was significantly shorter in the treated group (40 seconds) compared with the control group (120 seconds, P < .001). The mean operative time was significantly shorter in the treated group (36.4 ± 10.9 minutes) compared with the control group (45.9 ± 14.2 minutes, P < .001). Cervical tears occurred in nine (11.4%) patients in the control group and in one (1.4%, P = .018) in the misoprostol group. Creation of a false tract was more common in the control group. Two uterine perforations occurred in the placebo group. Conclusion Vaginal misoprostol applied before operative hysteroscopy reduced the need for cervical dilation, facilitated hysteroscopic surgery, and minimized cervical complications. Preoperative vaginal misoprostol facilitates hysteroscopic surgery and minimizes cervical complications.

Vaginal misoprostol for cervical priming before operative hysteroscopy: a randomized controlled trial

Objective: To investigate the effectiveness of vaginal misoprostol for cervical priming before operative hysteroscopy and to assess the cervicouterine complications related to cervical dilatation and hysteroscopic surgery in nulliparous women. Methods: One hundred fifty-two women with definite intrauterine lesions were randomly assigned to receive either 200 μg vaginal misoprostol or placebo. Cervical response and outcome and complications of operative hysteroscopy were assessed. Results: Thirty-five subjects were needed in each arm to detect a type I error of 0.01 with a power of 0.99. The mean cervical dilatation estimated by Hegar dilator was significantly different between the treated group (7.3 ± 0.7 mm) and the control group (3.8 ± 1.1 mm, P < .001). In the misoprostol group, 55 (75.3%) patients needed cervical dilation, compared with 75 (94.9%, P = .001) in the placebo group. The median time of cervical dilation to Hegar number 9 was significantly shorter in the treated group (40 seconds) compared with the control group (120 seconds, P < .001). The mean operative time was significantly shorter in the treated group (36.4 ± 10.9 minutes) compared with the control group (45.9 ± 14.2 minutes, P < .001). Cervical tears occurred in nine (11.4%) patients in the control group and in one (1.4%, P = .018) in the misoprostol group. Creation of a false tract was more common in the control group. Two uterine perforations occurred in the placebo group. Conclusion: Vaginal misoprostol applied before operative hysteroscopy reduced the need for cervical dilation, facilitated hysteroscopic surgery, and minimized cervical complications.

A Randomized Controlled Trial of Vaginal Misoprostol for Cervical Priming Before Hysteroscopy

In Brief Objective To evaluate the effectiveness and side effects of vaginal misoprostol for cervical dilation in nonpregnant women before hysteroscopy. Methods Ninety-one women scheduled to have hysteroscopy were randomized to receive either vaginal misoprostol or placebo. Cervical response, outcome of hysteroscopy, and side effects of vaginal misoprostol were assessed. Results The mean cervical dilatation estimated by Hegar dilator and the mean duration of hysteroscopy were significantly different between the treated group (7.0 ± 1.0 mm [range 6–8.5] and 90.0 ± 38.4 seconds [range 60–240], respectively) and the control group (3.8 ± 1.2 mm [range 2–5.5] and 142.0 ± 38.7 seconds [range 60–270]). In the misoprostol group, only three women (6.5%) needed cervical dilation before hysteroscopy, compared with 14 (31.1%) in the placebo group (P = .006). Cervical tears during hysteroscopy occurred in two patients (4.4%) in the control group and none in the misoprostol group. The two most common side effects of vaginal misoprostol were mild lower abdominal pain in 15 women (32.6%) and slight vaginal bleeding in 12 (26.1%). Both side effects were significantly different when compared with placebo (P < .001). Conclusion Vaginal misoprostol lessens the cervical resistance in women undergoing hysteroscopy and facilitates the procedure, with only mild side effects. Vaginal misoprostol reduces the need to dilate the cervix before hysteroscopy.

Randomized trial to determine optimal dose of vaginal misoprostol for preabortion cervical priming

Objective: To determine the optimal dosage of vaginal misoprostol for cervical priming before vacuum aspiration abortion. Methods: One hundred twenty women were assigned randomly to receive 200, 400, 600, or 800 μg of misoprostol given vaginally. Vacuum aspiration was performed 3–4 hours after the insertion of misoprostol tablets. The degree of cervical dilation before operation was measured with a Hegar dilator. Preoperative and intraoperative blood loss and associated side effects also were assessed. Results: Twenty-nine (96.7%) women in the 400-μg group and all in the 600-μg and 800-μg groups achieved cervical dilation of at least 8 mm. The success rate for the 200-μg group was only 23.3%, significantly less efficacious than the 400-μg dose (odds ratio 95.3; 95% confidence interval 10.9, 830.9; P < .001). There was no significant difference among the 400-, 600-, and 800-μg groups ( P = .364) with respect to achieving cervical dilation at least 8 mm. However, 800 μg was associated with significantly more side effects than 600 μg (preoperative and intraoperative blood loss, P < .001; abdominal pain, P = .005; products of conception at os, P < .001; fever higher than 38.0C, P = .002). When 400 μg and 600 μg were compared, we found that the higher dose also was associated with significantly more side effects. The 600-μg group was used twice in the comparison, but all P values remained significant even after the Bonferroni adjustment for multiple comparisons. Conclusion: Vaginal application of 400 μg of misoprostol is the optimal dose for vacuum aspiration preabortion cervical dilation in first-trimester nulliparas.