Cervical priming prior to operative hysteroscopy: a randomized comparison of laminaria versus misoprostol

Abstract

Both misoprostol and laminaria were equally effective in inducing proper cervical priming prior to operative hysteroscopy with minimal time of cervical dilatation. Nevertheless, misoprostol may be superior due to easy application, reduced cost, and patient convenience and acceptability.

Reconstructive Endoscopic Myomectomy

“…Preoperative cervical ripening with a prostaglandin analogue has been demonstrated to facilitate cervical dilation. In a controlled randomized study (66), we succeeded to prove that Misoprostol 200 mcg applied vaginally 8-12 hours prior to surgery is well tolerated and can decrease surgical time and reduce the risk of surgical complications.…”

“…It comprised combined resectoscopic and mechanical approaches to enucleate the myoma in a shorter time with minimal complication rate if compared to the standard morcellation technique. Moreover, it demonstrated some additive perioperative steps that facilitated the procedure like preoperative usage of misoprostol based on a RCT done by our team (66), intraoperative slow IV ergometrine administration, utilization of a novel hysteroscopic myoma driller, and performing a vertical incision on top of deeply impacted intramural myomata. If compared to a study on 44 cases published in the same year (78), the difference would be clear.…”

218: Comparison of Self-administered Vaginal Misoprostol Versus Placebo for Cervical Ripening Prior to Operative Hysteroscopy Using a Sequential Trial Design

“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Most of the studies have separately, but not systematically, compared the effect on different groups of women, such as nulliparous women and postmenopausal women. Eight of the studies included less than 50 women, 12,13,16,18,[20][21][22]25 four did not compare the effect of misoprostol with a placebo, [23][24][25]27 and ten of the trials appear to be underpowered or lacking a sample size calculation as regards to evaluating primary outcome measures. [11][12][13][16][17][18][20][21][22]26 It appears that none of the trials has been designed and conducted in accordance with the CONSORT statement.…”

“…[12][13][14][15][16][17][19][20][21][22][23][24][25][26][27] Less commonly, preoperative ripening is assessed by measuring cumulative dilatation force using a cervical tonometer. 11,13,16 Cervical resistance to dilatation or complications encountered during the procedure are also parameters that can indicate effectiveness of cervical ripening.…”

Clinical use of misoprostol for cervical ripening before transcervical procedures in non pregnant women: a randomized comparison of vaginal and sublingual administrations

“…4 The route of administration of misoprostol for cervical ripening and dilatation can be oral, vaginal and sublingual. However it is still unclear which route is more effective for cervical dilatation in non pregnant women before transcervical procedures.…”