Effectiveness of misoprostol administration for cervical ripening in women before operative hysteroscopy: a randomized, double-blinded controlled trial

Objective: To compare the effectiveness of misoprostol administration orally or vaginally for cervical ripening in women before operative hysteroscopy surgery. Material and methods: Two hundred seventy-five women eligible for operative hysteroscopy were recruited for a controlled, blinded, randomized trial. Twenty-two women were excluded from the study. Patients were randomly assigned to take 600??g of misoprostol or 30?mg vitamin B6 orally or vaginally, respectively, 4?12?h before operative hysteroscopy. Main outcome measures: Extent of cervical diameter before the hysteroscopy procedure, need for further cervical dilatation, degree of ease of cervical dilation, duration of additional cervix dilatation and hysteroscopy procedure, abdominal pain prior to surgical procedure, patients? acceptability, complications and associated side effects during the hysteroscopy procedures. Results: Cervical width in the vaginal and oral misoprostol groups after administration was 7.2???0.9?mm and 7.5???1.4?mm, respectively, a statistically significant difference compared to the control group. The duration required for cervical priming with misoprostol, either vaginally or orally (75???24?s or 82???22?s), was significantly shorter than that of placebo (148???31?s). The effect of cervical dilation with misoprostol was significantly higher in the premenopausal participants. Occurrence of uterine false tract substantially increased in the placebo group. Meanwhile, the risk of side-effects increased in the misoprostol-treated patients compared to the control group. Conclusions: The administration of misoprostol seemed more effective than the control for preoperative cervical priming in menstrual participants. Further large randomized controlled trials are needed to determine whether misoprostol could reduce complications with fewer side-effects and to establish whether misoprostol has a substantial cervical dilation effect on either premenopausal or postmenopausal patients.