Cervical ripening before operative hysteroscopy in premenopausal women: a randomized, double-blind, placebo-controlled comparison of vaginal and oral misoprostol

Objective To compare the effectiveness of oral and vaginal misoprostol for preoperative cervical ripening in premenopausal women before hysteroscopic surgery. Design Placebo-controlled, double blind, randomized trial. Setting University hospital. Patient(s) Eighty-six premenopausal women eligible for operative hysteroscopy were recruited. Nine women were excluded from the study. Intervention(s) Patients were randomly assigned to receive 400 μg of misoprostol orally (n = 39) or vaginally (n = 38), 10–12 hours before operative hysteroscopy. Main Outcome Measure(s) Extent of initial cervical width, percentage of patients requiring cervical dilatation, duration of cervical dilatation and surgical procedure, complications during procedure, and associated side effects. Result(s) Mean cervical widths in the vaginal and oral misoprostol groups after treatment were 7.3 ± 1.6 mm and 6.0 ± 1.5 mm, respectively, which was a statistically significant difference. Time required for cervical dilatation (98.6 ± 88.7 s vs. 49.1 ± 34.9 s) and duration of surgery (14.5 ± 6 vs. 7.7 ± 4.0 min) was statistically significantly shorter in the vaginal misoprostol group. The percentage of women with an initial cervical width of 9 mm was statistically significantly higher in the vaginal misoprostol group (36.8% vs. 5.1%). Uterine perforation occurred in two patients in the oral misoprostol group and in none in the vaginal misoprostol group. Side effects were comparable between the two treatment groups. Conclusion(s) Vaginal administration of misoprostol is more effective than the oral route for preoperative cervical ripening in premenopausal women.