Endometrial biopsy and hysteroscopy are important investigations in women presenting with abnormal vaginal bleeding. Endometrial biopsy is often performed as an outpatient procedure by endometrial aspiration. Difficulty in entering the internal cervical os may be encountered, especially in nulliparous women. The same problem may occur during hysteroscopy or dilatation and curettage. It is well known that use of a cervical priming agent is effective in reducing complications during cervical dilatation in pregnant women. However, its use in non-pregnant women is not well established. We compared oral misoprostol versus placebo for a cervical priming effect in non-pregnant women prior to hysteroscopy. The cumulative force required for cervical dilatation was significantly lower whereas the baseline cervical dilatation was significantly greater in the misoprostol group. We conclude that oral misoprostol is effective for pre-operative cervical dilatation in non-pregnant women.
PIP: Difficulties with entering the internal cervical os in nonpregnant women (especially nulliparous women) can hinder performance of endometrial aspiration or hysteroscopy in patients presenting with abnormal vaginal bleeding. This study investigated the usefulness of oral misoprostol--shown to be effective in cervical dilatation in first and third trimester abortion--for preoperative cervical dilatation in non-pregnant women. 44 nulliparous women presenting to Hong Kong's Queen Mary Hospital for diagnostic hysteroscopy and endometrial biopsy and curettage were randomly assigned to receive either 400 mcg of misoprostol 12 hours prior to the procedure (n = 21) or placebo (n = 23). Pretreatment with misoprostol significantly reduced the amount of force required to dilate the cervix to 8 mm from 103.7 Newtons in controls to 40.0 Newtons in women treated with misoprostol. The mean baseline cervical dilatation was significantly greater in the misoprostol group (6.0 mm) than in controls (3.3 mm). There were no immediate intraoperative complications and all women were discharged within 12 hours of the procedure. Another potential use of misoprostol is for cervical dilatation prior to IUD insertion in nulliparous women.