الفهرس 
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Abstract
Summary
Operative hysteroscopy is an important tool for the management of intrauterine abnormalities. Complications encountered during the procedure are partly related to difficulties in cervical dilatation. These include cervical tears, creation of a false track, hemorrhaging, uterine perforation requiring laparoscopy, or simply difficulty in entering the internal cervical os with the resectoscope.
The incidence of these complications can be reduced if the cervix is ripened before the procedure by inserting laminara into the cervical canal the night before surgery or by using Sulprostone gel.
Misoprostol, a synthetic prostaglandin E1 analogue widely prescribed for prevention and treatment of gastric ulcers, has been shown to have cervical ripening effects in both pregnant and non-pregnant patients when administered either orally or vaginally.The systemic bioavailability of misoprostol is three times greater when it is administered vaginally than orally and suggests that vaginal administration could be dosed at longer intervals than oral. The purpose of this randomized, placebo controlled study was to evaluate the effectiveness of vaginal misoprostol in facilitating cervical dilatation in pre- and post-menopausal women before operative hysteroscopy and to identify the best dose.
The aim of the present study is to investigate whether 1000 micrograms of self-administered vaginal misoprostol 12 hours before operative hysteroscopy results in effective preoperative cervical ripening compared with placebo..
100 patients were included in this study, they were subjected to vaginal Self- administration of either misoprostol or placebo 12hs prior to operative hysteroscopy.
Our trials show that 1000 microgram misoprostol self-administered vaginally by the woman 12 hours before operative hysteroscopy is safe and effective for cervical ripening compared with placebo in premenopausal but not in postmenopausal women. Self-administered vaginal capsules at home were considered highly acceptable; adverse effects were few and comparatively minor.
The operations were planned independently of menstrual cycle and, consequently, while the trial was underway, we discovered an effect modifier that we had not considered prior to study commencement: some premenopausal women with bleeding disorders bled so profusely before insertion of the capsules, that the active ingredient most likely was ‘washed out’ of the vagina without having any effect on cervical ripening.
Our study shows high significance (70%) on preoperative cervical dilatation (equal and more than5mm) in premenopausal group compared to placebo which is insignificant (30%).
On contrary both shows no big difference on preoperative cervical dilatation in postmenopausal group which may need preoperative hormonal treatment for cervical stenosis. We speculate that whether the lack of estrogen is the main reason why misoprostol does not have any significant effect. We therefore feel that further investigations, as to whether a short course of local hormone therapy combined with misoprostol might have a positive cervical ripening effect on postmenopausal women, are warranted.