Sublingual misoprostol for cervical ripening before diagnostic hysteroscopy in premenopausal women: A randomized, double blind, placebo-controlled trial

Mulayim, Baris; Çelik, Nilüfer; Önalan, Göğşen; Bağış, Tayfun; Zeyneloglu, Hulusi Bulent

doi:10.1016/j.fertnstert.2009.01.073

Cited by 27 publications

(14 citation statements)

References 14 publications

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“…[19][20][21] Administration in close proximity to the procedure may result in a suboptimal response, even if administered sublingually. 22 It is important to note that misoprostol may be ineffective as a cervical ripening agent in postmenopausal women, 21,23 however, the addition of systemic estrogen administration for 2 weeks before the procedure may provide results similar to those reported for premenopausal women. 24 In addition, there exists high-quality evidence that cervical ripening with sublingual administration of 400 mg misoprostol is more effective in postmenopausal women compared with alternative routes of administration.…”

Section: Risk Reduction Recognition and Management Of Access-relatementioning

confidence: 91%

Complications of Hysteroscopic and Uterine Resectoscopic Surgery

Munro

Christianson

2015

Clinical Obstetrics &Amp; Gynecology

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Adverse events associated with hysteroscopic procedures are generally rare, but, with increasing operative complexity, it is now apparent that they are experienced more often. There exists a spectrum of complications that relate to generic components of procedures, such as patient positioning, anesthesia, and analgesia, to a number that are specific to intraluminal endoscopic surgery that largely comprise perforation and injuries to surrounding structures and blood vessels. Whereas a number of endoscopic procedures require the use of distending media, the response of premenopausal women to excessive absorption of nonionic fluids used for hysteroscopy is somewhat unique, and deserves special attention on the part the surgeon. There is also an increasing awareness of uncommon but problematic sequelae related to the use of monopolar radiofrequency uterine resectoscopes that involve thermal injury to the vulva and vagina. Furthermore, the uterus that has previously undergone hysteroscopic surgery may behave in unusual ways, at least in premenopausal women who experience menstruation or who become pregnant. Fortunately, better understanding of the mechanisms involved in these adverse events, as well as the use or development of a number of innovative devices, have collectively provided the opportunity to perform hysteroscopic and resectoscopic surgery in a manner that minimizes risk to the patient.

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Section: Risk Reduction Recognition and Management Of Access-relatementioning

confidence: 91%

Complications of Hysteroscopic and Uterine Resectoscopic Surgery

Munro

Christianson

2015

Clinical Obstetrics &Amp; Gynecology

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The present study was conducted at Aretaieio Hospital, Athens, Greece, and LHTO Maternity Hospital, Athens, Greece from March 2005 to November 2010.

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confidence: 99%

“…minimally invasive surgery. Varied and more complex gynecological procedures have been performed as surgeons become more familiar with the technique[1].…”

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confidence: 99%

Misoprostol for cervical ripening before diagnostic hysteroscopy in nulliparous women

Bakas

Hassiakos

Liapis

et al. 2011

Intl J Gynecology & Obste

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Misoprostol has been used for cervical preparation before diagnostic hysteroscopic procedures, but there is no agreement on the recommended dose, route, or time of administration [1,2]. The aim of the present study was to compare the efficacy of 3 different misoprostol regimens for cervical ripening before diagnostic hysteroscopy in nulliparous women.The present study was conducted at Aretaieio Hospital, Athens, Greece, and LHTO Maternity Hospital, Athens, Greece from March 2005 to November 2010. All participants provided informed consent and the Ethical Committee of Aretaieio Hospital approved the study. Indications for diagnostic hysteroscopy were 3 failed attempts at intrauterine insemination with controlled ovarian stimulation using gonadotropins; at least 1 failed attempt at in vitro fertilization or intracytoplasmic sperm injection; menometrorrhagia; and intrauterine pathology detected by hysterosalpingography or transvaginal ultrasound. Inclusion criteria were nulliparous, premenopausal women who were fit to undergo the procedure. Exclusion criteria were any possible contraindications to the use of prostaglandins; parity; history of previous cervical procedures such as loop excision, cone biopsy, or previous dilatation and curettage; and contraindications to hysteroscopy such as active infection, bleeding, pregnancy, or suspicion of malignancy.Eligible patients were randomly allocated using a computergenerated sequence into 3 groups: group A (n = 39) received 200 μg of misoprostol orally at 12 hours and 6 hours before hysteroscopy; group B (n = 36) received 200 μg of misoprostol vaginally 12 hours before hysteroscopy; and group C (n = 35) received 200 μg of misoprostol vaginally 4 hours before hysteroscopy.Hysteroscopy was performed during the early follicular phase of the cycle. The primary outcome measure was the degree of preoperative cervical dilation required (if the hysteroscope could not be inserted) using Hegar dilators up to size 5 and introduced without force. Secondary outcome measures were time taken to dilation to introduce a Hegar dilator size 5, development of uterine or cervical injury during the procedure, development of intrauterine bands as a result of the procedure, and complications secondary to the use of misoprostol.The characteristics of the patients are shown in Table 1. A significant difference was found in the need for cervical dilation between groups A and C (12.8% vs 74.1%; P b 0.001) and between groups B and C (16.6% vs 74.1%; P b 0.001). In addition, there was a significant difference in the duration of cervical dilation to a size 5 dilator between groups A and C (35.3 ± 18 vs 63.7 ± 23 s; P b 0.001) and between groups B and C (37.5 ± 21 vs 63.7 ± 23 s; P b 0.001) ( Table 2).There were no significant differences in the occurrence of adverse effects between groups A and C, or between groups B and C (P > 0.05) ( Table 3).The group C regimen did not reduce the need for cervical dilation, which supports the findings of Singh et al. [3]. The findings of the present study are in ag...

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“…Only a few studies evaluated the effectiveness of sublingual misoprostol for cervical ripening in non-pregnant premenopausal women undergoing hysteroscopy. In agreement, Mulayim et al [21] compared the effectiveness of 200 μg sublingual misoprostol vs. placebo and found that less patients needed cervical dilatation in the misoprostol group whereas, the duration of dilatation was longer in the placebo group. Also, Lee et al [22] compared sublingual to oral/vaginal misoprostol before hysteroscopic procedures in non-pregnant premenopausal women.…”

Section: Discussionmentioning

confidence: 72%

Prostaglandins prior to hysteroscopy

Moiety¹,

Azzam²

2011

Gynecol Surg

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This prospective randomized controlled study was conducted to assess the role of misoprostol, given sublingually or rectally, on the outcome of hysteroscopic procedures. A total of 212 premenopausal patients undergoing hysteroscopic procedures were randomly allocated into three groups: group 1 (n=71), sublingual misoprostal given 2 h before the procedure; group 2 (n=71) rectal misoprostal 2 h before the procedure; group 3 (n=70), control group, no medications were given. Main outcome measures were ease of cervical dilatation, dilatation time to Hegar 6, complications as cervical laceration and postoperative cramps, bleeding and pyrexia. The cervical canal at the start was significantly wider misoprostol groups (P= 0.038). Cervical dilatation was significantly easier in the rectal misoprostol group over control (P=0.035). Misoprostol groups showed significant reduction in the mean time needed to dilate to Hegar 6 (P=0.021). Postoperative pain and cramps were significantly higher in misoprostol groups (P=0.002). Misoprostol before hysteroscopy demonstrates a benefit in the ease of cervical dilatation, cervical width at the start and time for dilatation with low risk of cervical tears. Rectal misoprostol appears advantageous than sublingual one. However, postoperative adverse effects are more common with misoprostol groups.

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Sublingual misoprostol for cervical ripening before diagnostic hysteroscopy in premenopausal women: A randomized, double blind, placebo-controlled trial

Cited by 27 publications

References 14 publications

Complications of Hysteroscopic and Uterine Resectoscopic Surgery

Complications of Hysteroscopic and Uterine Resectoscopic Surgery

Misoprostol for cervical ripening before diagnostic hysteroscopy in nulliparous women

Prostaglandins prior to hysteroscopy

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