Vaginal Misoprostol for Cervical Priming before Operative Hysteroscopy in Misurata Hospital, Libya

Aisha  M. Elbareg; Mohamed  El Sirkasi; Fathi  M. Essadi; Mohamed  O. Elmahashi; Ishag  Adam

doi:10.52981/sjms.v10i2.1052

Aisha M. Elbareg Misurata University
Mohamed El Sirkasi Medical Technology, Misurata University
Fathi M. Essadi Medical Technology, Misurata University, Misurata
Mohamed O. Elmahashi Misurata University, Misurata,
Ishag Adam University of Khartoum

DOI: https://doi.org/10.52981/sjms.v10i2.1052

Keywords: Misoprostol,, cervical priming,, hysteroscopy,, Libya.

Abstract

Background: Operative hysteroscopy has gained popularity as a minimally invasive
approach in the management of intrauterine abnormalities. Cervical dilatation represents a
real challenge during the procedure. Misoprostol, a synthetic prostaglandin E1 analogue has
a cervical ripening effect in both pregnant and non-pregnant patients.
Objectives: To investigate vaginal misoprostol in facilitating cervical dilatation prior to
operative hysteroscopy.
Material and Methods: This was an open controlled clinical trial conducted at Misurata,
Libya. Patients were randomized into two groups of (60 each): misoprostol group received
400 μg misoprostol (cytotec), self-administered vaginally 3-4 hrs prior to the operation
(hysteroscopy) and control group received no treatment.
Results: The two groups were well matched in their age, parity, presentations and indications
of the procedure. Compared with the controls, significantly more cervical dilatation was
achieved in significantly shorter time in misoprostol group. Likewise the duration of the
operative hysteroscopy was also significantly shorter in the misoprostol group. Significantly
fewer patients in misoprostol group had cervical lacerations, creation of false passage during
cervical dilatation and uterine perforations.
Conclusion: In summary, the study showed that vaginal misoprostol administered 3-4 hour
before operative hysteroscopy reduce the need for cervical dilatation and facilitate
hysteroscopic surgery.

References

1. Ghahiry AA, Refaei Aliabadi E, Taherian AA,Najafian A, Ghasemi M. Effectiveness ofhysteroscopic repair of uterine lesions inreproductive outcome. Int J Fertil Steril. 2014;8(2):129-34
2. Bradley LD. Complications in hysteroscopy:prevention, treatment and legal risk. CurrOpin Obstet Gynecol. 2002; 14:409-415.
3. Jansen FW, Vredevoogd CB, Van Ulzen K, etal. Complications of hysteroscopy: aprospective multicentre study. ObstetGynecol. 2000; 96:266-270.
4. Wortman M. Complications of hysteroscopicsurgery. In: Isaacson K, editor. Complicationof Gynecological Endoscopic Surgery.Philadelphia: Saunders Elsevier; 2006. P. 185-200.
5. Rath W, Kuhn W, Hilgers R. Facilitation ofcervical dilatation by intra cervical applicationof sulprostone gel prior to hysteroscopy.Endoscopy 1985; 17:191-193.
6. Hald F, kristoffersen SE,Gregresen E.Prostaglandin vaginal suppositories innonpregnant women required cervicaldilatation prior to hysteroscopy. Acta ObstetGynecol Scand 1988; 67:219-222.
7. Thomas JA, Leyland N, Durand N, WindrimRC. The use of oral misoprostol as a cervicalripening agent in operative hysteroscopy: adouble-blind, placebo controlled trial. Am JObstet Gynecol 2002; 186: 876-879.
8. Preutthipan S, Herabutya Y. A randomizedcomparison of vaginal misoprostol anddinoprostone for cervical ripening innulliparous women before operativehysteroscopy. Fertil Steril 2006; 86:990-994.
9. Lee YY, Kim TJ, Kang H, Choi CH. The usemisoprostol before hysteroscopic surgery innon-pregnant premenopausal women: arandomized comparison of sublingual, oral andvaginal administration. Hum Reprod 2010;25:1942-1948.
10. Darwish AM, Ahmed AM, Mohammad AM.Cervical priming prior to operativehysteroscopy: a randomized comparison oflaminaria versus misoprostol. Hum Reprod2004; 19: 2391-2394.
11. Dan Yu, Tin-Chin Li, Enlan Xia, XiaowuHuang. A prospective, randomized, controlledtrial comparing vaginal misoprostol andosmotic dilator in achieving cervical ripeningbefore operative hysteroscopy. Gynecol Surg
2006, 3:186-189.
12. Lin YH, Hwang JL, Seow KM, HuangLW, Chen HJ, Hsieh BC. Laminaria tentvs misoprostol for cervical primingbefore hysteroscopy: Randomized study. JMinim Invasive Gynecol 2009; 16(6):708-12.
13. Goldberg AB, Greenberg MB, Darney PD.Misoprostol and pregnancy. N Engl J Med2001; 344:38-47.
14. Austin SC, Sanchez-Ramos L, Adair CD.Labor induction withintravaginal misoprostol compared with thedinoprostone vaginal insert: a systematicreview and met analysis. Am J ObstetGynecol 2010; 202(6):624.
15. Batukan C, Ozgun MT, Ozcelik B, AygenE, Sahin Y, Turkyilmaz C. Cervical ripeningbefore operative hysteroscopy inpremenopausal women: a randomized, doubleblind,placebo-controlled comparison ofvaginal and oral misoprostol. FertilSteril 2008; 89(4):966-973.
16. Tanha FD, Salimi S, Ghajarzadeh M.Sublingual versus vaginal misoprostol forcervical ripening before hysteroscopy: arandomized clinical trial. Arch GynecolObstet 2013; 287(5):937-40.
17. Song T, Kim MK, Kim ML, Jung YW, YoonBS, Seong SJ. Effectiveness of differentroutes of misoprostol administration beforeoperative hysteroscopy: a randomized,controlled trial. Fertil Steril 2014; 102(2):519-24.
18. Zieman M, Fong SK, Benowitz NL, et al.Absorption kinetics of misoprostol with oral orvaginal administration. Obstet Gynecol 1997;90: 88-92.
19. El- refacy H, Calder L, Wheatley DN,Templeton A. Cervical priming withprostaglandin E1 analogues, misoprostol andgemeprost. Lancet 1994; 343:1207-1209.
20. Goyal B, Roy P, Bhat P, Das N, Paul K,Duggal B. Intracervical versus vaginalmisoprostol for cervical dilatation prior tooperative hysteroscopy-a comparative study.Med J Armed Forces India. 2012; 68(2):129-31.
21. Arena S, Zupi E, Affronti G. Cervical ripeningprior to hysteroscopy: is the application ofmisoprostol useful. Minerva Ginecol 2011;63(5):439-48.
22. El-Mazny A, Abou-Salem N. A double-blindrandomized controlled trial of vaginalmisoprostol for cervical priming beforeoutpatient hysteroscopy. Fertil Steril 2011;96(4):962–965.
23. Sordia-Herna´ndez LH, Rosales-Tristan E,Vazquez-Mendez J, et al. Effectiveness ofmisoprostol for office hysteroscopy withoutanesthesia in infertile patients. Fertil Steril2011; 95(2):759–761.
24. Oppegaard KS, Nesheim B-I, Istre O, QvigstadE. Comparison of self-administered vaginalmisoprostol versus placebo for cervicalripening prior to operative hysteroscopy usinga sequential trial design. Br J Obstet Gynecol.2008; 115(663):eI-e9.
25. Uckuyu A, Ozcimen EE, Sevinc FC,Zeyneloglu HB. Efficacy of vaginalmisoprostol before hysteroscopy for cervicalripening in patients who have undergonecesarean section and no vaginal deliveries. JMinim Invasive Gynecol. 2008; 15: 472-475.
26. Gkrozou F, Koliopoulos G, Vrekoussis T et al.,A systematic review and meta-analysis ofrandomized studiescomparing misoprostol versus placebo forcervical ripening prior to hysteroscopy. Eur JObstet Gynecol Reprod Biol 2011; 158(1):17-23.
27. Preutthipan S, Herabutya Y. A randomizedcontrolled trial of vaginal misoprostol forcervical priming before hysteroscopy. ObstetGynecol. 1999; 93:427-430.
28. Preutthipan S, Herabutya Y. Vaginalmisoprostol for cervical priming beforeoperative hysteroscopy: a randomizedcontrolled trial. Obstet Gynecol. 2000;96:890-894.