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