Effect of Vaginal Misoprostol on Cervical Priming in Diagnostic Dilatation and Curettage

Document Type : Original Article

Authors

1 Assistant professor of Obstetrics & Gynecology, Iran University of Medical Sciences, Tehran, Iran.

2 Associate professor of Obstetrics & Gynecology, Iran University of Medical Sciences, Tehran, Iran.

3 Resident in Obstetrics & Gynecology, Iran University of Medical Sciences, Tehran, Iran.

Abstract

Introduction:Dilatation of cervix is essential for dilatation and curettage and hysteroscopy as well. Complications encountered during the procedure are partly related to difficulties in cervical dilatation. Finding the materials which can cause cervical dilatation more easily is important. The purpose of the present study is to evaluate the effect of vaginal Misoprostol on priming the cervix before dilatation in patients who are candidate for this procedure.
Methods: A randomized clinical trial was performed on 60 women who were candidated for D&C. In 30 patients (case group), 200 mg Misoprostol (one tablet) was administered in posterior fornix of vagina 4 hours before operation, whereas in other 30 patients (control group), placebo was used. Then the two groups were compared according to their need to Hagar dilatator thinner than number 5 for dilatation of cervix and the duration of dilatation and curettage.
Results: It was revealed that measures like age, parity and previous delivery methods did not show a statistically significant difference between two groups. 6 patients (20%), in the case group, and 26 (87%) in the control group needed the Hager dilatator number 5 to dilate the cervix (P<0.005) which their difference was statistically significant. The mean duration of D&C in the control group was 19±4 minute versus 12.7±2.8 minute in case group which showed a statistically significant difference (P<0.001).
Conclusion: Vaginal misoprostol is a suitable agent for priming the cervix in order to dilate more easily before D&C.

Keywords


1. Cooper KG, Pinion SB, Bhattacharya S, Parkin DE. The effects of the gonadotropin releasing hormone analogue
(goserelin) and prostaglandin E1 (misoprostol) on cervical resistance before trans-cervical resection of the
endometrium. BJOG 1996;103:375-8.
2. Darwish AM, Ahmad AM, Mohammad AM. Cervical priming prior to operative hysteroscopy: a randomized
comparison of laminaria versus misoprostol. Hum Reprod 2004;19:2391-4.
3. Fernandez H, Alby JD, Tournoux C, Chauveaud-Lambling A, De Tayrac R, Frydman R. Vaginal misoprostol for
cervical ripening before operative hysteroscopy in pre-menopausal women: a double-blind, placebo- controlled
trial with three dose regimens. Hum Reprod 2004;19:1618-21.
4. Preutthipan S, Herabutya Y. A randomized controlled trial of vaginal misoprostol for cervical priming before
hysteroscopy. Obstet Gynecol 1999;94:427-30.
5. Collins PW. Misoprostol: discovery, development and clinical application. Med Res Rev 1990;10:149-72.
6. Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption Kinetics of misoprostol with oral or
vaginal administration. Obstet Gynecol 1997;90:88-92.
7. Crane JM, Healey S. Use of misoprostol before hysteroscopy: a systematic review. J Obstet Gynaecol Can
2006;28(5):373-9.
8. Healey S, Butter B, Kum FN, Dunne J, Hutchens D, Crane JM. A randomized trial of oral misoprostol in
premenopausal women before hysteroscopy. J Obstet Gynecol Can 2007;29(8):648-52.
9. Thomas JA, Leyland N, Durand N, Windrim RC. The use of oral misoprostol as a cervical ripening agent in
operative hysteroscopy: a double- blind, placebo- controlled trial. Am J Obstet Gynecol 2002;186(5):876-9.
10. Barcaite E, Bartusevicius A, Railaite DR, Nadisauskiene R. Vaginal misoprostol for cervical priming before
hysteroscopy in perimenopausal and postmenopausal women. Int J Gynaecol Obstet 2005;91(2):141-5.
11. Preutthipan S, Herabutya Y. A randomized comparison of vaginal misoprostol and dinoprostone for cervical
priming in nulliparous women before operative hysteroscopy. Fertile Steril 2006;86(4):990-4.
12. Oppegaard KS, Nesheim BI, Istre O, Qvigstad E. Comparison of self-administered vaginal misoprostol versus
placebo for cervical ripeining prior to operative hysteroscopy using a sequential trial design. BJOG
2008;115(5):661.
13. Fung TM, Lam MH, Wong SF, Ho LC. A randomized placebo-controlled trial of vaginal misoprostol for
cervical priming before hysteroscopy in postmenopausal women. BJOG 2002;109(5):561-5. 
 
14. Bunnasathiansri S, Herabutya Y, O- Prasertsawat P. Vaginal misoprostol for cervical priming before dilatation and
curettage in postmenopausal women: a randomized controlled trial. J Obstet Gynaecol Res 2004;30(3):221-5.
15. Preutthipan S, Herabutya Y. Vaginal misoprostol for cervical priming before operative hysteroscopy: a
randomized controlled trial. Obstet Gynecol 2000;96(6):890-4.
16. Ngai SW, Chan YM, Liu KL, Ho PC. Oral misoprostol for cervical priming in non pregnant women.
Hum Reprod 1997;12(11):2373-5.
17. Choksuchat C, Chee wadhanaraks S, Getpook C, Wootipoom V, Dhanavoravibul K. Misoprostol for cervical
ripening in non-pregnant women: a randomized double- blind controlled trial of oral versus vaginal regimens.
Hum Reprod 2006;21(8):2167-70.