A prospective, randomized, controlled trial comparing vaginal misoprostol and osmotic dilator in achieving cervical ripening before operative hysteroscopy

Yu, Dan; Li, Tin‐Chiu; Xia, Enlan; Huang, Xiaowu

doi:10.1007/s10397-006-0199-8

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…However, Dam et al, and Perrone et al, did not find any promising effect in pre-menopausal women, rather it has caused more pain and uterine cramping. 16,17 Similarly in another study, post-menopausal women also didn't benefit from misoprostol usage. 18 Misoprostol can be administered oral, vaginal, sublingual, buccal or rectal for effective cervical dilatation and ripening.…”

Section: Discussionmentioning

confidence: 91%

Use of vaginal misoprostol before endometrial biopsy in premenopausal women: an observational study

Prabhavathi

Prasad

Lahari

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Background: It is well-known since long time the beneficial effects of misoprostol particularly as a cervical softening agent in obstetric practice. Keep in view, study aimed to evaluate the efficacy of vaginal misoprostol 400 mcg before endometrial biopsy in premenopausal women.Methods: All the 200 patients were classified into two groups viz. study group (Group I) with 100 patients and control group (Group II) with 100 patients. To Group I patients, 400 mcg of misoprostol was given vaginally, 4 hours prior to the commencement of endometrial biopsy whereas no medication was received by Group II patients.Results: In the present study, the base line cervical dilatation is found to be 5.8±1.3 mm in Group I patients whereas 3.8±0.92 mm in Group II patients which is significantly higher (p<0.05). Only 32 patients in Group I required further dilatation whereas 88 patients in Group II underwent further dilatation. The mean time required for further dilatation in Group I and Group II patients was 42.6±17.4, 64.6±16.8 sec respectively and was significantly higher in Group II patients (p<0.05). Out of 100 patients in Group I, only 2% of patients complained severe pain whereas in Group II 48% of patients experienced intolerable pain and required anesthesia.Conclusions: Vaginal administration of 400 mcg misoprostol 4 hours prior to endometrial biopsy in premenopausal women had a significant effect on cervical resistance and cervical dilatation.

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Section: Discussionmentioning

confidence: 91%

Use of vaginal misoprostol before endometrial biopsy in premenopausal women: an observational study

Prabhavathi

Prasad

Lahari

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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“…Many interventions were tried to make dilatation easier as preliminary administration of lamineria tents or misoprostol to soften cervix. Difficulty and/or resistance to dilatations remain an important issue in some cases with stenosed cervix [3][4][5][6][7][8] The most common type of cervical injury is a superficial laceration caused by the vulsellum or Allis forceps tearing off during dilation. At the other extreme are the cervico vaginal fistula and the longitudinal laceration ascending to the level of the uterine vessels.…”

Section: Discussionmentioning

confidence: 99%

“…Although these methods were successful in many patients giving little time and effort in cervical dilatation, but these methods were not adequately effective in patients with previous cesarean deliveries and cervical fibrosis or stenosis. Cervical stenosis remains an obstacle for safe hysteroscopic procedures as it requires more time, effort and associated with many complications as cervical lacerations, bleeding or potential cancellation of the procedure [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

A New Technique for Minimizing Cervical Trauma and Enhancing Surgical Performance in Gynecological Procedures Requiring Cervical Dilatation

Dawood¹,

Raslan²

2017

Int J Gynecol Clin Pract

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Objectives: To minimize cervical trauma, enhance performance and reduce complications during gynecological operations requiring cervical dilatations.Patients and methods: This study was conducted on 200 women in child bearing age scheduled for operative hysteroscopy for a variety of conditions as infertility or abnormal uterine bleeding. Patients were randomly allocated into two groups according to method of cervical traction. Cervical stitch for patients in group I (n =100), while using vulsellum in group II (n =100). This study was done at Tanta University Hospitals in the period from October 1, 2015 to September 30, 2016. All demographic data, operative type, cervical trauma, operative bleeding or cervical lacerations were gathered and analyzed.Results: All patients' demographic data were statistically non-significant in the studied groups. The operative time required for cervical dilatation was shortened in group I (10.66±2.70 minutes) compared to (18.2±1.45 minutes) with P value = 0.02. No complications occurred in group I while bleeding occurred in group II due to excessive force against the vulsellum with multiple applications and slipping of the vulsellum leading to more lacerations and more bleeding. Additional measures were used in group II only to stop or minimize complications.Conclusions: Cervical stitch applied before gynecological procedures requiring cervical dilatation was more effective and helpful than vulsellum use and was not associated with any cervical trauma, lacerations, or bleeding.

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“…Only one study has evaluated a synthetic osmotic dilator for cervical preparation before operative hysteroscopy. [ 13 ] Dilapan-S is a 2 nd -generation synthetic osmotic dilator made from hygroscopic polyacrylonitrile called AQUACRYL. There are no studies comparing the efficacy of Dilapan-S versus misoprostol in cervical preparation before operative hysteroscopy.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Efficacy of Vaginal Misoprostol versus a Synthetic Osmotic Dilator (Dilapan-S) for Cervical Preparation before Operative Hysteroscopy: A Randomized Controlled Study

Nair,

Subbaiah,

Maurya

2023

Gynecology and Minimally Invasive Therapy

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Objectives: To compare the need for mechanical cervical dilatation following vaginal misoprostol or synthetic osmotic dilator (Dilapan-S) usage for cervical preparation before operative hysteroscopy. Materials and Methods: Fifty-five premenopausal women scheduled for operative hysteroscopic procedures with a 26 Fr resectoscope were included in this randomized, controlled clinical trial. After randomization, either 400 μg of vaginal misoprostol or intracervical synthetic osmotic dilator (Dilapan-S) was inserted 12 h before operative hysteroscopy. The need for additional mechanical cervical dilatation before insertion of the resectoscope was compared between the two groups. Initial cervical diameter before mechanical dilatation, intraoperative complications (cervical tears, creation of a false passage), and ease of dilatation were also compared between the two groups. Results: In the misoprostol group, 92% of women required additional mechanical cervical dilatation, whereas only 36% of women in the Dilapan-S group required additional dilatation (P < 0.05). The median initial cervical diameter achieved with Dilapan was 9 mm (Q1: 7 mm; Q3: 10 mm), and with misoprostol, it was 6 mm (Q1: 4.5 mm; Q3: 8 mm) (P < 0.05). There was no significant difference in other outcome parameters between the two groups. Conclusion: Synthetic osmotic dilator (Dilapan-S) is more efficacious than vaginal misoprostol at ripening the cervix before operative hysteroscopy.

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A prospective, randomized, controlled trial comparing vaginal misoprostol and osmotic dilator in achieving cervical ripening before operative hysteroscopy

Cited by 8 publications

References 17 publications

Use of vaginal misoprostol before endometrial biopsy in premenopausal women: an observational study

Use of vaginal misoprostol before endometrial biopsy in premenopausal women: an observational study

A New Technique for Minimizing Cervical Trauma and Enhancing Surgical Performance in Gynecological Procedures Requiring Cervical Dilatation

Comparison of Efficacy of Vaginal Misoprostol versus a Synthetic Osmotic Dilator (Dilapan-S) for Cervical Preparation before Operative Hysteroscopy: A Randomized Controlled Study

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