Published: 2020-12-26

Comparative study of the effectiveness of two different dosage of sublingual misoprostal for cervical ripening before hysteroscopy

Komal Jadon, Indu Chawla, Kanika Kumari


Background: Hysteroscopy a minimally invasive approach for evaluating uterine cavity, and has become an indispensable diagnostic and therapeutic procedure. The main limiting factor while performing office hysteroscopy is the level of pain or discomfort encountered during the procedure. The pain is attributed mainly to the difficulty in entering the internal cervical os with the hysteroscope and while distending uterine cavity. It could be reduced if cervix is ripened before the procedure. The purpose of this prospective observational study was to compare the effectiveness, adverse effects and surgery-related complications associated with two different doses of sublingual Misoprostol (100 and 200 µg) given 2-4 hours before hysteroscopy.

Methods: A randomised comparative study was conducted in the department of Obstetrics and Gynaecology of ABVIMS and Dr. RML hospital New Delhi, from 1st November, 2018 to 31st March, 2020. One hundred and twenty women, fulfilling inclusion criteria were subjected to hysteroscopy. Women received either 100 µg (Group I) or 200 µg (Group II) of sublingual Misoprostol 2-4 hours prior to hysteroscopy. The primary outcome of the study was cervical dilatation as measured by the largest number of Hegar dilator that could be inserted without resistance at the beginning of procedure. The largest dilator that negotiated cervical canal without resistance at the beginning of procedure was recorded as the baseline cervical width. The secondary outcomes were subjective assessment of the surgeon of the ease of dilatation of cervix and adverse effects of drug (i.e. vaginal bleeding, shivering, fever and pain as measured on visual analog scale).

Results: The mean baseline cervical width as measured by first Hegar dilator that could be passed through the cervical canal without resistance was 6.6±0.62 mm in group I and 6.94±1.21 mm in group II respectively                    (p value=0.016). Adverse effects like vaginal bleeding, shivering was more in group II compared to group I. No statistically significant difference was found between group I and II with regards to visual analog scale.

Conclusions: 100 µg Misoprostol can be used for cervical ripening prior to hysteroscopy with minimal adverse effects.


Cervical ripening, Hysteroscopy, Misoprostol, Sublingual

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Baggish MS, Valle RF, Guedj H, editors. Hysteroscopy: Visual perspectives of uterine anatomy, physiology and pathology, 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins. 2007:496.

Jansen FW, Vredevoogd CB, Ulzen K, Hermans JO, Trimbos JB, Kemper TC. Complications of hysteroscopy: a prospective, multicenter study. Obst Gynecol. 2000;96(2):266-70.

Bradley LD. Complications in hysteroscopy: prevention, treatment and legal risk. Current Opinion Obst Gynecol. 2002;14(4):409-15.

Javier MD. Role of mechanical dilatation of cervix in hysteroscopy. World. 2008;1(2):20-2.

Al‐Fozan H, Firwana B, Al Kadri H, Hassan S, Tulandi T. Preoperative ripening of the cervix before operative hysteroscopy. Cochrane Database Syst Rev. 2015;4:76-9.

Hamoda H, Ashok PW, Flett GM, Templeton A. A randomized controlled comparison of sublingual and vaginal administration of misoprostol for cervical priming before first-trimester surgical abortion. Am J Obst Gynecol. 2004;190(1):55-9.

Kesrouani A, Maalouf S, Mansour F, Attieh E. Use of oral misoprostol for cervical priming before hysteroscopy: a randomized comparison of two dosages. Gynecol Obstetric Investigation. 2016;81(4):333-8.

Ayyad W. Cervical priming with sublingual misoprostol prior to office hysteroscopy: a randomized controlled trial. Al-Azhar Assiut Med J. 2015;13(3):2.

Al-Hilli NM. Effect of different doses of sublingual misoprostol on pain experience during office hysteroscopy. Annals Trop Med Health. 2020;23:75-83.

Gupta T, Ahmad SN, Kumari S. Comparative study of efficacy and adverse effects of different doses of vaginal misoprostol for cervical ripening 10-12 hours before diagnostic hysteroscopy. Int J Reprod Contracep Obstet Gynecol. 2018;7(3):1065-9.

Hua Y, Zhang W, Hu X, Yang A, Zhu X. The use of misoprostol for cervical priming prior to hysteroscopy: a systematic review and analysis. Drug Design Development Therapy. 2016;10:2789.

Bisharah M, Al-Fozan H, Tulandi T. A randomized trial of sublingual misoprostol for cervical priming before hysteroscopy. J Am Association Gynecol Laparoscopists. 2003;10(3):390-1.

El-Khayat W, Elsawah H, Idris O. A double-blind randomized controlled trial of two different doses of misoprostol for cervical priming prior to office hysteroscopy. Middle East Fertility Soc J. 2015;20(1):1-5.

Mulayim B, Celik NY, Onalan G, Bagis T, Zeyneloglu HB. Sublingual misoprostol for cervical ripening before diagnostic hysteroscopy in premenopausal women: a randomized, double blind, placebo-controlled trial. Fertil Steril. 2010;93(7):2400-1.

Saha M, Chakraborty A, Chattopadhyay S, Saha S, Paul J, Das A. Effect of misoprostol for cervical priming before gynecological procedures on nonpregnant premenopausal women. J Natural Sci Biol Med. 2015;6(1):S123.