"Self-administered vaginal misoprostol is safe and effective for cervical ripening in non-pregnant premenopausal women undergoing operative hysteroscopy, clinicians from Norway report in the April issue of
BJOG: An International Journal of Obstetrics and Gynecology."We would recommend offering this inexpensive and easy-to-use regimen to nulliparous premenopausal women prior to undergoing operative hysteroscopy to reduce the risk of complications and facilitate cervical dilatation," they conclude.
"There is a risk of lower abdominal pain and light preoperative bleeding with this regimen and women should be made aware of this and offered standard analgesics," Dr. Kevin S. Oppegaard from Helse Finnmark, Klinikk Hammerfest, and colleagues suggest.
They point out in their report that the efficacy of misoprostol for cervical ripening in pregnant women before first-trimester suction curettage abortion is well established, whereas the effect of misoprostol for cervical ripening in nonpregnant women to prevent cervical injury during dilatation is not.
Dr. Oppegaard and colleagues compared self-administered vaginal misoprostol (1000 micrograms) versus placebo for cervical ripening 12 hours before outpatient operative hysteroscopy in 86 women, 65 of whom were premenopausal.
The investigators found that misoprostol had a significant cervical ripening effect compared with placebo in premenopausal but not postmenopausal women. In premenopausal women, the mean cervical dilatation was 6.4 mm with misoprostol versus 4.8 mm with placebo -- a mean difference of 1.6 mm.
Among premenopausal women in the misoprostol arm, 88 per cent achieved a cervical dilatation of 5 mm or greater compared with 65 per cent in the placebo arm. Twelve per cent of premenopausal women receiving misoprostol were difficult to dilate compared with 32 per cent receiving placebo. Dilatation was also quicker with misoprostol.
As mentioned, misoprostol had no effect on cervical ripening in postmenopausal women, relative to placebo. Dr. Oppegaard and colleagues think it would be worthwhile to investigate whether a short course of local hormone therapy combined with misoprostol might have a positive cervical ripening effect in postmenopausal women.
At-home self-administered misoprostol the evening before operative hysteroscopy was "safe and highly acceptable" to the majority of women, the researchers found.
"Most women did not experience misoprostol-related adverse effects," they report. However, a small proportion of women (three of 45) experienced severe lower abdominal pain and there was an increased occurrence of light preoperative bleeding with the misoprostol regimen.
Source: Reuters"
