Use of Oral Misoprostol for Cervical Priming before Hysteroscopy: A Randomized Comparison of Two Dosages

Abstract

Objective: The study aims to compare the safety and effectiveness of 200 and 400 µg of oral misoprostol for cervical priming before hysteroscopy. Methods: A double-blinded randomized study included 70 patients scheduled for hysteroscopy in a Lebanese University Hospital. Two dosages of oral misoprostol (200 or 400 µg) were randomly distributed to these patients 1 h before surgery under general anesthesia. Subjective assessment of the ease of dilatation, size of the first used Hegar, cervical injuries, bleeding or uterine perforation, duration of the procedure and misoprostol adverse effect were all noted and compared. Results: The difficulty of dilation until a Hegar 10 was similar for both treatment groups. Operative time was not reduced with a higher misoprostol dosage. We found 2 uterine perforations within the 200 µg group (6.7%), and none within the 400 µg group. Cervical lacerations and bleeding were similar (20%) for both treatment groups. A 2-fold increase in side effects (nausea, vomiting and cramps) is reported among the 400 µg group. Conclusions: Increasing the dose of misoprostol from 200 to 400 mg doubled the rate of side effects while no clinical benefit was noted. Larger trials are needed to assess rates of uterine perforation with the 200 µg dosage.

Comparative study of the effectiveness of two different dosage of sublingual misoprostal for cervical ripening before hysteroscopy

“…Kesrouani et al reported in their study abnormal vaginal bleeding (40%) as most common indication followed by polyps (33%), myoma (13%), endometrial thickening (10%). 7 Study done by Ayyad et al had primary infertility (80%) as main indication for hysteroscopy. 8 Similarly study conducted by Al Hilli et al documented irregular vaginal bleeding (48.9%) followed by infertility (22.7%) as an indication of hysteroscopy.…”

Misoprostol for cervical priming prior to hysteroscopy in postmenopausal and premenopausal nulliparous women; a multicentre randomised placebo controlled trial

“…When we consider the administration of misoprostol we believe that route and schedule are appointed correctly, as illustrated in the Materials and Methods section. Some studies have indicated that a lower dose of 200 microgram might demonstrate a similar effect . Furthermore, side effects might occur less frequently when misoprostol is administrated vaginally instead of orally .…”

Authors' reply re: Misoprostol for cervical priming prior to hysteroscopy in postmenopausal and premenopausal nulliparous women; a multi‐centre randomised placebo controlled trial

“…As Mr Kesrouani correctly points out, adverse effects occurred significantly more often in this group compared with placebo: more nausea (17% [misoprostol] versus 11% [placebo]) as well as abdominal pain (24% [misoprostol] versus 15% [placebo]) . His dose‐finding study was able to demonstrate a relation between dosage and adverse effects: higher rates of nausea (11% [400 micrograms] versus 6% [200 micrograms]) and abdominal pain (25% [400 micrograms] versus 13% [200 micrograms]) …”

“…We would like to take the opportunity to thank Mr Kesrouani for his positive response to our paper, published in the January issue of BJOG . We referred to his thorough, dose‐finding randomised trial in our discussion, regarding the possibility of using a lower dose of misoprostol …”