Clinical use of misoprostol prior to transcervical procedures in non-pregnant women

Misoprostol, a synthetic prostaglandin E1 analogue, is commonly used for medical abortion, cervical priming and the management of miscarriage, induction of labor and the management of postpartum hemorrhage. It can be given orally, sublingually, vaginally and rectally. It has been widely used in non-pregnant women because of its cervical ripening and uterotonic effects. A large number of studies have demonstrated its effectiveness in enhancing ease of cervical dilatation. This review article describes the pharmacokinetics and clinical use of the drug misoprostol in non-pregnant women including cervical priming before hysteroscopy, before insertion of an intrauterine device, in endometrial biopsy and before intrauterine insemination to improve pregnancy rates.

effect of 1000 microgram vaginal misoprostol on preoperative cervical ripening before diagnostic hysteroscopy

To compare the effect of 1000 microgram vaginal misoprostol on preoperative cervical ripening before diagnostic hysteroscopy in premenopausal -women with abnormal uterine bleeding. This study was conducted in Gynae/Obs Unit-II, Holy Family Hospital, Rawalpindi, from 22[nd] of January 2009 to 22 of July 2009. The data were collected from 70 women on a pre-structured proforma admitted to inpatient department for diagnostic hysteroscopy with abnormal uterine bleeding, Inclusion criteria were women above 40 years of age, previously delivered vaginally or by caesarean section and with previous cervical dilation and biopsy. An exclusion criterion was pregnancy, pelvic infection, and cervical cancer. The women were randomized to two groups of 35 each. In group A: women were given 1000mcg misoprostol vaginally 12 hours preoperatively to diagnostic hysteroscopy and in group B: women were taken as controls i.e. they underwent hysteroscopy without any drug for cervical dilatation. The effect of preoperative cervical dilatation was measured by passing Hegar dilators. Cervical dilatation of >/= 5 mm was considered as satisfactory and the duration of cervical dilatation and hysteroscopy were noted in both groups. Among the premenopausal women receiving misoprostol, 88% [n=31] achieved cervical dilatation of >5mm compared with 65% [n=23] in the control group. The mean cervical dilatation in group A was 6.4 mm and 4.8 mm in group B. The mean difference in cervical dilatation was 1.6 mm [95% CI 0.5- 2.7], with a p- value<0.001. The mean time for cervical dilatation was 47 seconds in group A and 68 seconds in group B, with a p-value <0.001. Mean duration of hysteroscopy in minutes, in group A was 15 minutes whereas in group B it was 23 minutes. One thousand micrograms of vaginal misoprostol 12 hours prior to hysteroscopy has a significant cervical ripening effect requiring less instrumentation as compared with control group in premenopausal women. Duration of hysteroscopy is also reduced in women treated with vaginal misoprostol as less instrumentation was required for cervical dilatation. Vaginal misoprostol 1000 microgram before hysteroscopy is safe, and is highly acceptable by the patient.