Misoprostol's preoperative cervical ripening effect
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AbstractProstaglandins are recommended for preoperative cervical ripening before surgical abortion, although the ideal dose, route and timing for misoprostol is debated.
Prostaglandins appear to be effective for cervical ripening in nonpregnant women although few trials with the power to evaluate primary efficacy outcome levels have been conducted.
The ideal misoprostol dose, route and timing for cervical ripening before hysteroscopy in premenopausal women has not been established.
WHAT THIS STUDY ADDS
Four hundred micrograms oral misoprostol before surgical abortion has a similar cervical ripening effect but a higher rate of side effects, compared with two hundred micrograms self-administered vaginal misoprostol. One thousand micrograms vaginal misoprostol is effective for cervical ripening in premenopausal, but not postmenopausal women before hysteroscopy. After 14 days of local estradiol therapy, postmenopausal women also achieve a cervical ripening effect with one thousand micrograms vaginal misoprostol. Self-administered vaginal misoprostol is a highly acceptable, practical and inexpensive method to achieve preoperative cervical ripening.
List of papers
I The use of oral misoprostol for pre-abortion cervical priming: a randomised controlled trial of 400 versus 200 Ag in first trimester pregnancies. Kevin S. Oppegaard, Mikael Abdelnoor, Britt-Ingjerd Nesheim, Fridtjof Jerve, Anne Eskild. DOI: 10.1046/j.1471-0528.2003.00045.x BJOG: an International Journal of Obstetrics and Gynaecology. 2004 ; Vol. 111, pp. 154-159.
II Oral versus self-administered vaginal misoprostol at home before surgical termination of pregnancy: a randomised controlled trial. Kevin Sunde Oppegaard,Erik Qvigstad, Britt-Ingjerd Nesheim. BJOG. 2006;113(1):58-64. DOI: 10.1111/j.1471-0528.2005.00798.x
III Comparison of self-administered vaginal misoprostol versus placebo for cervical ripening prior to operative hysteroscopy using a sequential trial design.Oppegaard K, Nesheim B, Istre O, Qvigstad E. DOI: 10.1111/j.1471-0528.2007.01628.x.BJOG 2008;115:663, e1-9.
IV A COMBINATION OF MISOPROSTOL AND ESTRADIOL FOR PREOPERATIVE CERVICALRIPENING IN POSTMENOPAUSAL WOMEN: A RANDOMISED CONTROLLED TRIAL. Oppegaard KS, Lieng M, Berg A, Istre O, Qvigstad E, Nesheim B-I. BJOG 2010;117:53-61. DOI: 10.1111/j.1471-0528.2009.02435.x