Cervical priming by misoprostol before diagnostic dilatation and curettage: a randomized clinical trial

Difficulty in cervical dilatation is a hard situation during the procedure of diagnostic dilatation and curettage in some cases. This study was performed to evaluate the effect of vaginal misoprostol for cervical priming before diagnostic dilatation and curettage. In this study 56 women were selected as the candidates for dilatation and curettage. The study was double blind and was performed for two parallel groups. One misoprostol tablet [200 micro g] was administered in posterior fornix of vagina 2-4 hr before operation in 28 patients whereas in other 28 patients, placebo [VitB6] was used. Then, the two groups were compared according to the patency of the cervix measured by No. 5 Hegar dilators and the duration of dilatation and curettage procedure as well. Chi-square test, t-test, and Mann-Whitney U test were used for comparing two groups, and a p-value less than 0.05 was considered as statistically significant. Before the procedure of dilatation and curettage, the patency of the cervix was measured by passing Hegar dilator number 5 through the cervical canal in fifteen [53.6%] patients in the misoprostol group and 8 patients [28.6%] in the placebo group [p=0.05] which their difference was statistically significant. The effect of misoprostol was not significant in nulliparous women and postmenopausal period either. Vaginal misoprostol is a useful drug for ripening and dilating the cervix. It also facilitates the procedure of dilatation and curettage in premenopausal and multiparous women. Misoprostol was less effective in nulliparous women and in postmenopausal period

Outcome of subsequent pregnancies in familial molar pregnancy

Familial recurrent molar pregnancy is an exceedingly rare condition, in which complete hydatidiform moles are mostly diploid but biparental in origin and the outcome of subsequent pregnancies is likely to be a hydatidiform mole or other type of reproductive loss. We previously reported a case of familial molar pregnancy [family K] comprising five affected members [four sisters and one of their cousins] each with at least one hydatidiform mole [HM]. In addition to the molar pregnancies, these patients have a total of three miscarriages and 8 normal pregnancies leading to healthy children; but the youngest member of this family has given birth to a boy with Down syndrome. Our second family [case S] includes two sisters with diploid biparental complete moles. They have a total of six molar pregnancies with no living child. Recently the younger sister had a partial molar pregnancy with apparently normal XX fetus accompanying diffuse molar changes of the placenta that led to preeclampsia and preterm delivery. Overall, these families have had 26 pregnancies including 12 molar pregnancies [complete or partial] and three abortions. We concluded that these families are predisposed to various genetic mutations, chromosomal abnormalities and clinical manifestations, which affect their offspring. Further studies of patients are needed to determine any relationship between a history of familial molar pregnancy and trisomy or other chromosomal abnormalities in offspring and genetic mutations in the products of conception to complete the puzzle and manage familial molar pregnancy