Comparative Effect of Vaginal Nitroglycerin and Misoprostol on Cervical Preparation before Hysteroscopy: A Randomized Clinical Trial

Document Type : Original Article

Authors

1 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

2 Professor, Department of Obstetrics and Gynecology, Endometriosis Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

3 PhD of Pharmacy, School of Pharmacy, Islamic Azad University, Tehran, Iran.

4 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran.

5 Associate Professor, Department of Obstetrics and Gynecology, Firoozabadi Clinical Research Development Unit (FACRDU), Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

6 Gynecologist, Department of Obstetrics and Gynecology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

10.22038/ijogi.2025.80918.6128

Abstract

Introduction: Hysteroscopy is used to evaluate intrauterine pathology before and after menopause, especially in cases of abnormal uterine bleeding, infertile patients, and suspected uterine abnormalities. Nitric oxide-releasing drugs such as isosorbide mononitrate, isosorbide dinitrate, nitroglycerin, and sodium nitroprusside prepare the cervix without causing uterine contractions and can be used as outpatient. The present study was conducted with aim to compare the effects of nitroglycerin with misoprostol on cervical preparation before hysteroscopy.
Methods: This double-blind clinical trial was conducted in 2022-2023 on 90 patients who were candidates for hysteroscopy and referred to Rasoul Akram Hospital in Tehran. In the first intervention group (A), nitroglycerin tablets were used, and in the second intervention group (B), two misoprostol tablets were used, and the rate of cervical ripening was examined with graded dilators in both groups. Data analysis was performed using SPSS statistical software (version 22) and Student's t-test, Mann-Whitney U, Chi-square, and Fisher's exact tests. P<0.05 was considered significant.
Results: The two groups were similar in terms of baseline characteristics such as age, body mass index, previous childbirth, and cervical status, and there were no statistically significant differences (p>0.05). Although both drugs were effective in preparing the cervix for hysteroscopy, the misoprostol group reported significant adverse events such as abdominal cramps and nausea (91.9%), while the nitroglycerin group had no complications. In addition, postoperative bleeding was significantly less in the nitroglycerin group (17.8%) compared with the misoprostol group (95.6%) (p=0.001).
Conclusion: Given the similar effectiveness of nitroglycerin and misoprostol in the rate of unresisted cervical dilation, the use of vaginal nitroglycerin is preferable to vaginal misoprostol due to its better effectiveness in reducing patient pain, reducing bleeding after hysteroscopy, and the absence of side effects.

Keywords

Main Subjects

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The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 28, Issue 6
August 2025
Pages 1-14

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