Cervical Priming by Vaginal or Oral Misoprostol Before Operative Hysteroscopy: A Double-Blind, Randomized Controlled Trial

Abstract Study Objective To evaluate whether misoprostol oral is as effective as vaginal tablets for cervical ripening. Design Randomized controlled trial involving a parallel, double-blinded study (Canadian Task Force Classification IB). Setting Department of Obstetrics and Gynecology, Cairo University Hospital, between January 2014 and January 2016. Patients Patients undergoing operative hysteroscopy for various indications. Interventions At 12 hours before hysteroscopy, the oral group received a 400-μg misoprostol tablet and 2 vaginal starch tablets. The vaginal group received 400 μg of misoprostol and 2 oral starch tablets. The control group received 2 oral starch and 2 vaginal starch tablets as placebo. Preoperative preparation was the same in all patients. Measurements and Main Results The main outcome measures were width of the endocervical canal, ease of dilatation, time to dilatation, and adverse effects. All subjects eligible for operative hysteroscopy (n = 430) were invited to participate. Twenty subjects refused, and 20 subjects were excluded. The enrolled subjects (n = 390) were randomized to oral misoprostol, vaginal misoprostol, or placebo. The differences in mean width of the endocervical canal between the oral and the control groups (4.79 ± 1.07 mm vs 3.92 ± 0.92 mm), and also between the vaginal and the control groups (4.25 ± 0.71 mm vs 3.92 ± 0.92 mm) were significant (p   .05). Conclusion We found no statistically significant difference in the efficacy of cervical priming between oral misoprostol and vaginal misoprostol.