Instruments and TechniquesEfficacy of Vaginal Misoprostol Before Hysteroscopy for Cervical Priming in Patients Who Have Undergone Cesarean Section and No Vaginal Deliveries
Section snippets
Materials and Methods
Patients of reproductive age referred to the Konya Investigation and Practice Center of Baskent University from September 2003 through September 2007, who had undergone a cesarean section at least once and were scheduled for operative hysteroscopy for various medical conditions were included in the study. The indications for cesarean section were presentation abnormalities and elective. Patients who had delivered vaginally, those who had undergone any transcervical or transabdominal uterine and
Results
The groups were similar with regard to age, number of previous cesarean section operations, and number of months since the last cesarean operation (Table 1). The indications for hysteroscopy and intraoperative findings were similar in both groups (Table 1). Mean cervical width, as determined with a Hegar bougie, was larger in patients in the study group (6.5 ± 0.8 mm) than it was in patients in the control group (3.0 ± 0.6 mm) (p <.0001). Complication and failure rates were lower in patients in
Discussion
This is the first randomized controlled study in which the whole population is comprised of patients who have undergone cesarean section at least once and who have never had vaginally deliveries before. Our results show that vaginal misoprostol is more effective in reducing cervical resistance than placebo. Misoprostol has proved to be effective for cervical priming throughout pregnancy [9]. Although data on efficacy of misoprostol for cervical ripening before transcervical interventions in
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Cited by (19)
Endometrial ablation
2018, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :The principles of accessing the endometrial cavity via the cervical canal are beyond the scope of this paper. Because most resectoscope systems have an outer diameter of 8–9 mm, substantial dilation is necessary, a part of the procedure facilitated by the preoperative use of misoprostol or laminaria [23–25], or the intraoperative injection of dilute vasopressin into the cervical stroma [26]. There are several techniques whereby the resectoscope can be used to direct endometrial destruction or ablation (Fig. 3).
A systematic review and meta-analysis of randomized controlled trials on the effectiveness of cervical ripening with misoprostol administration before hysteroscopy
2016, International Journal of Gynecology and ObstetricsCitation Excerpt :The initial search yielded 255 records (Fig. 1). A total of 32 trials were potentially suitable for inclusion in the meta-analysis [9–40]. The other trials were excluded because data on cervical ripening were not available in the papers and could not be obtained from the original investigators.
Use of misoprostol in gynaecology
2014, Journal de Gynecologie Obstetrique et Biologie de la ReproductionIntracervical versus vaginal misoprostol for cervical dilatation prior to operative hysteroscopy-a comparative study
2012, Medical Journal Armed Forces IndiaCitation Excerpt :Vaginally administered misoprostol before hysteroscopic surgery makes mechanical cervical dilatation easier. A number of placebo-controlled studies have attested to the efficacy of misoprostol for this purpose.1–9 We found that even though pre-operative cervical dilatation with vaginal misoprostol to 5 mm or 6 mm is usual, difficulty in achieving full dilatation up to 9–10 mm is frequently encountered.
AAGL Practice Report: Practice Guidelines for the Diagnosis and Management of Submucous Leiomyomas
2012, Journal of Minimally Invasive GynecologyCitation Excerpt :PROSTAGLANDINS (MISOPROSTOL). High-quality evidence from RCTs suggests that misoprostol, a synthetic prostaglandin E1 analogue (200–400 μg) taken orally or vaginally, 12 to 24 hours before surgery, facilitates cervical dilation and minimizes traumatic complications in premenopausal women [120–127]. There is evidence from 1 RCT involving postmenopausal women that vaginal estradiol, 25 μg/d, for 2 weeks, followed by vaginal misoprostol (1000 μg) the evening before the procedure, resulted in a significantly more “ripe” cervix than was the case for misoprostol alone [128].
A systematic review and meta-analysis of randomized studies comparing misoprostol versus placebo for cervical ripening prior to hysteroscopy
2011, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :One would assume that misoprostol would be better suited for women who have only delivered by caesarean section compared to those that had vaginal deliveries, as the latter usually have a degree of cervical canal dilatation anyway. Indeed one of the included studies concerned women who have undergone caesarean section without any vaginal deliveries, and in this the hysteroscopy complication rate was significantly lower after misoprostol [29]. In addition side effects seem to be statistical significant even if only a low dose (200 μg) of vaginal misoprostol were administrated.
The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.