Page 18 - WALS Journal
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Role of Mechanical Dilatation of Cervix in Hysteroscopy
            either orally or vaginally. The dosages given in the studies  REFERENCES
            varied from 200 and 1000 mcg given between 2-24 hours before
            the surgery, via oral, sublingual or vaginal route. One of the  1. Clark TJ, Volt D, Gupta JK, Hyde C, Song F, Khan KS.
                                                                    Accuracy of hysteroscopy in the diagnosis of endometrial cancer
            studies compared the effect of laminaria tents against placebo.  and hyperplasia: a systematic quantitative review. JAMA. 202;
            The patients were randomly assigned into two groups. They  288: 161-62.
            underwent hysteroscopic procedure with a 5-10 mm     2. American College of Obstetricians and Gynecologists. ACOG
            hysteroscope during the follicular phases of their cycle. The  Technology assessment in obstetrics and gynecology, number
            cervical width was assessed by the largest number of Hegar  4, August, 2005: hysteroscopy. Obstet Gynecol. 2005; 106:
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            Subjective assessment of the ease of the dilatation to 9 mm by  3. Guido R. Stovall D Hysteroscopy Version 14.3. Uptodate (cited
            the surgeon was also recorded. Adverse effects like pre-  February 15, 2007).
            operative pain, mild lower abdominal pain and slight vaginal  4. Bradley LD. Complications in hysteroscopy: prevention,
            bleeding were recorded.                                 treatment, and legal risk. Curr Opin Obstet Gynecol 2002; 14:
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                                                                 5. Grimes DA, Schulz KF, Cates WJ Jr. Prevention of uterine
            DISCUSSION                                              perforation during curettage abortion. JAMA 1984; 251: 2108-
            Recently, hysteroscopy has been used to investigate women  11.
            presenting with abnormal uterine bleeding (Nagele et al, 1996).  6. Schulz KF, Grimes DA, Cates W. Measures to prevent cervical
            Hysteroscopy plus sampling the endometrial tissue increased  injury during suction curettage abortion. Lancet 1983; 1:
                                                                    1182-84.
            the sensitivity and specificity for the detection of endometrial  7. Lichtenberg ES. Complications of osmotic dilators. Obstet
            pathology when compared with blind endometrial biopsy alone.  Gynecol Surv 2004; 59: 528-36.
            However, difficulty in cervical dilatation has been one of the  8. Blanchard K, Clark S, Winikoff B, Gaines G, Kabani G, Shannon
            major causes of failure of this procedure (Scottish Hysteroscopy  C. Misoprostol for women’s health. Obstet Bynecol 2002; 99:
            Audit Group, 1995). The articles reviewed showed that vaginal  316-32.
            misoprostol applied pre-operatively facilitates cervical priming  9. Yu D, Li T-c, Xia E, Huang X. A prospective, randomized,
            and reduced the need for cervical dilation, facilitated the ease  controlled trial comparing vaginal misoprostol and osmotic dilator
            of diagnostic and operative hysteroscopy and minimized cervical  in achieving cervical ripening before operative hysteroscopy.
            complications. One article mentioned that both misoprostol and  Gynecological Surgery 2006; 3: 186-89.
            laminaria were equally effective. Nevertheless, misoprostol is  10. Aslan G, Yuce MA, Gucer F. A comparison of vaginal and oral
            superior over the laminaria due to easy application, cheap cost  routes in misoprostol administration for cervical priming before
                                                                    hysteroscopy: a prospective randomized double-blind study.
            and convenience and better acceptability to the patient. Both  Jinekoloji Ve Obstetrik Dergisi 2004; 18: 145-49.
            oral and vaginal misoprostol showed no significant difference  11. Fung TM, Lam MH, Wong SF, Ho LC. A randomized placebo-
            with respect to cervical opening, duration of dilation as well as  controlled trial of vaginal misoprostol for cervical priming before
            the rate of complications. Most studies of dosing have involved  hysteroscopy in postmenopausal women. BJOG 2002; 109;
            the use of vaginal misoprostol administration with dosages of  561-65.
            200 microgram to 400 microgram given 9-12 hours before  12. Thomas JA, Leylans N, Durand N, Windrim RC. The use of oral
            hysteroscopy showing the greatest benefit. One review showed  misoprostol as a cervical ripening agent in operative
            that misoprostol application is safe and effective for cervical  hysteroscopy: a double blind, placebo controlled trial. Am J
            priming against placebo in premenopausal women but not in  Obstet Gynecol 2002; 186: 876-79.
            postmenopausal women. Misoprostol is a drug used for the  13. Preutthipan S, Herabutya Y. A randomized controlled trial of
                                                                    vaginal misoprostol for cervical priming before hysteroscopy.
            treatment of peptic ulcer disease. The cost is cheap, self-  Obstet Gynecol 1999; 93: 427-30.
            administration is easy and does not require hospital resources  14. Ngia SW, Chan YM, Liu KL, Ho PC. Oral misoprostol for
            in application, other than information.                 cervical priming in non-pregnant women. Hum Reprod 1997;
                                                                    12: 2373-75.
            CONCLUSION                                          15. Preutthipan S. Herabutya Y. Vaginal misoprostol for cervical
                                                                    priming before operative hysteroscopy, a randomized controlled
            In conclusion, methods of cervical priming and dilation before  trial. Obstet Gynecol 2000; 96: 890-94.
            hysteroscopy negate the need of further dilating the cervix at  16. Fernandez H, Alby JD, Tournox C, Chauveaud-Lambling A, de
            the operation theater prior to the procedure. Among the methods  Tayrac R, Frydman R, et al. Vaginal misoprostol for cervical
            offered in the market, misoprostol is highly superior in the  ripening before operative hysteroscopy in premenopausal
            cervical ripening before hysteroscopy due to cheap cost, easy  women: a double-blind, placebo controlled trial with three dose
            to apply and mild side effects.                         regimens. Human Reprod 2004; 19: 1618-21.




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