Abstract and Introduction
Abstract
Background: The aim of the present study was to evaluate the efficacy of misoprostol administered orally, vaginally, or sublingually on cervical ripening before hysteroscopic surgery in premenopausal non-pregnant women.
Methods: Non-pregnant premenopausal women scheduled for operative hysteroscopy (with a 10-mm hysteroscope) were assigned by computerized randomization to receive 400 mg of misoprostol, administered either orally or vaginally 6–8 h prior to surgery or 400 mg sublingually 2–4 h prior to surgery. The primary outcome in this study was the preoperative cervical width as measured by the largest number of Hegar dilators. The time to Hegar number 10 was also recorded along with side effects related to misoprostol and complications during surgery for each group.
Results: Patients were randomized to receive sublingual (n = 47), oral (n = 47) or vaginal (n = 47) misoprostol. The three groups were comparable in terms of age, BMI (body mass index), parity, gravidity, history of vaginal delivery, post-operative pathological findings and surgeon type. The preoperative cervical width [sublingual: 7.5 ± 2.0 mm (8, 3–10); oral: 7.5 ± 1.9 mm (7, 4–10); vaginal: 7.6 ± 2.4 mm (8, 1–10)] was statistically similar among the groups. The time to Hegar number 10, side effects and complications during the hysteroscopy were comparable among the three groups.
Conclusion: A limitation of this study was that the surgeons, but not the patients, were blinded to the test procedures. Nevertheless we found that sublingual, oral and vaginal misoprostol were equally effective for cervical priming before hysteroscopic surgery in premenopausal non-pregnant women.
Introduction
Hysteroscopic surgery, with prior cervical ripening by misoprostol (analog prostaglandins E1, PGE1), has been widely used to treat gynecological diseases including submucosal myoma, endometrial polyps and uterine synechia in non-pregnant women (Crane and Healey, 2006; Fiala et al., 2007). Misoprostol has been shown to be equally effective when compared with laminaria in inducing cervical priming prior to hysteroscopic surgery with minimal time required for cervical dilatation, easy administration, reduced costs and increased patient convenience (Darwish et al., 2004).
The route of administration of misoprostol for cervical dilatation can be oral, vaginal or sublingual. However, it is still unclear which route is more effective for cervical dilation before transcervical procedures in non-pregnant premenopausal women. Two prior reports compared the effects of preoperative oral and vaginal misoprostol on cervical ripening before hysteroscopic surgery. One study found that vaginal administration was more effective than the oral route for preoperative cervical ripening in non-pregnant premenopausal women (Batukan et al., 2008), while the other found no difference between the two routes (Choksuchat et al., 2006). In addition, the sublingual route was effective when compared with the vaginal (Tang et al., 2004; Carbonell Esteve et al., 2006) and the oral routes (Aronsson et al., 2004) for pregnancy termination. However, there have been no studies comparing sublingual administration to the other routes in non-pregnant premenopausal women with gynecologic disorders.
The aim of the present study was to evaluate the efficacy of 400 µg of misoprostol administered orally, vaginally or sublingually for cervical ripening before hysteroscopic surgery in premenopausal non-pregnant women.