Comparison between 200 μg and 800 μg of vaginal misoprostol for cervical ripening before operative hysteroscopy: A randomized controlled trial

Abstract

Objective To compare between 200 and 800 μg of vaginal misoprostol for cervical ripening before operative hysteroscopy. Methods Quadruple‐blind randomized clinical trial conducted between November 2019 and September 2020 involving 76 patients undergoing cervical dilatation before surgical hysteroscopy at teaching hospitals in Pernambuco, Brazil. Women received the vaginal misoprostol dosage of 200 or 800 μg,10–12 h before operative hysteroscopy. The cervical width was the primary outcome, and secondary outcomes were patient satisfaction, adverse effects, surgical complications, and duration of cervical dilatation. Chi‐square tests of association, Fisher's exact and Mann–Whitney U tests were used with an α error of <5%. Results There was no statistical difference between the groups in the mean of the cervical width (800 μg: 6.5 ± 1.6 mm vs 200 μg: 5.8 ± 1.8 mm, P = 0.055), patient satisfaction, and surgical findings, but the duration of cervical dilatation was lower in the 800‐μg group (28.16 ± 28.5 s vs 41.97 ± 31.0 s, P = 0.035). Among the adverse effects, diarrhea was more frequent in the 800‐μg group with statistical difference (100% vs 0%; P = 0.01). Conclusion For cervical ripening, 200 μg misoprostol is equally effective with fewer adverse effects than 800 μg before operative hysteroscopy. ClinicalTrials.gov: NCT04152317. https://clinicaltrials.gov/ct2/show/NCT04152317.

Optimizing Operative Hysteroscopy in the Office Setting: Updated Techniques and Technology

“…A recent randomized controlled trial looked at dosage effects of vaginal misoprostol, at a dose of 200 µµg compared with 800 µg administered 12 hours before operative hysteroscopy, and adverse effects were more common in the 800-µg group. 10 For postmenopausal patients, a 14-day pretreatment of vaginal estradiol combined with 1000 µg of vaginal misoprostol 12 hours before hysteroscopy provided a benefit when compared with placebo. 11 A systematic review by Cooper et al 12 further examined the perceived benefit of prostaglandins alone in postmenopausal patients and found that the marginal benefits were restricted to use of largerdiameter hysteroscope systems such as those more than 5 mm.…”

“…Side effects also appear to be dose dependent. A recent randomized controlled trial looked at dosage effects of vaginal misoprostol, at a dose of 200 μμg compared with 800 μg administered 12 hours before operative hysteroscopy, and adverse effects were more common in the 800-μg group 10…”

Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology

“…The use of misoprostol, a prostaglandin E1 analogue, has been extensively studied in preoperative cervical ripening, with formulations ranging from 200 to 800 micrograms administered orally or vaginally three to 24 hours before the procedure. 2,37–42 Benefits of misoprostol include improved ease of cervical entry, decreased procedure length, and reduced intraoperative and postoperative pain scores. 1,38,39 The most common side effects include mild abdominal pain, vaginal bleeding, nausea, diarrhea, and increased body temperature, 37,43 though these are usually well-tolerated in our experience.…”