Department of Obstetrics & Gynaecology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (Deemed-to-be-University), Pillaiyarkuppam, India.
J Obstet Gynaecol. 2022 Aug;42(6):2297-2301. doi: 10.1080/01443615.2022.2042224. Epub 2022 Apr 25.
This study aimed to compare the effect of misoprostol using vaginal or sublingual routes on the non-pregnant uterine cervix prior to minor gynaecological procedures. One hundred and forty women were randomised 1:1 into two groups: A and B. Group A received misoprostol 400 mcg vaginally and pyridoxine 40 mg sublingually and Group B received misoprostol 400 mcg sublingually and pyridoxine 40 mg vaginally 4 h prior to procedure. The outcomes studied were maximum size of Hegar's dilator that could be inserted into the cervix without any resistance, ease of dilatation, need and time required for further dilatation, side effects and complications. Baseline cervical dilatation was significantly more in Group A than Group B. Need for further dilatation and time required for further dilatation were also significantly less in Group A than Group B. Thus, we conclude that vaginal misoprostol is more effective than sublingual misoprostol in cervical priming before minor gynaecological procedures. www.ctri.nic.in; CTRI/2018/07/015080 IMPACT STATEMENT Cervical priming has been shown to result in shorter operative time, easier mechanical dilatation, reduced incidence of complications and blood loss when used prior to surgical abortion and has been recommended as a standard practice in various national and international guidelines for safe abortion practices. Misoprostol has many advantages over other ripening agents like osmotic dilators, other prostaglandins and mifepristone. Misoprostol can be given through oral, sublingual, vaginal, buccal and rectal routes. Use of misoprostol has been found to improve cervical dilatation, reduce need of further dilatation and ease of dilatation without many complications when compared to placebo for cervical priming of non-pregnant cervix. Studies comparing vaginal and sublingual routes have shown no significant difference for cervical ripening in pregnant women. We found that vaginal misoprostol for cervical priming was more effective than sublingual misoprostol in reaching a higher baseline cervical dilatation, with reduced need and time required for further dilatation before minor gynaecological procedures, although the ease of dilatation was similar in both groups. This effect of vaginal misoprostol was more marked in premenopausal women. The results of our study are at variance with other studies done on use of misoprostol via the vaginal or sublingual routes, and hence it is imperative that large multi-center studies be performed to bring about consensus on the topic.
本研究旨在比较米索前列醇经阴道或舌下途径用于非妊娠子宫颈在小妇科手术前的效果。将 140 名妇女随机分为两组：A 组和 B 组，每组 1:1。A 组给予米索前列醇 400 mcg 阴道给药和吡哆醇 40 mg 舌下给药，B 组给予米索前列醇 400 mcg 舌下给药和吡哆醇 40 mg 阴道给药，在手术前 4 小时。研究的结果是能够无阻力插入宫颈的最大号 Hegar 扩张器的尺寸、扩张的难易程度、进一步扩张的需要和所需时间、副作用和并发症。基线宫颈扩张在 A 组明显大于 B 组。A 组进一步扩张的需要和进一步扩张所需的时间也明显少于 B 组。因此，我们得出结论，阴道给予米索前列醇比舌下给予米索前列醇在小妇科手术前宫颈预处理中更有效。www.ctri.nic.in; CTRI/2018/07/015080 影响陈述 宫颈预处理已被证明可缩短手术时间、更容易进行机械扩张、减少并发症的发生率和出血量，在手术流产前使用，并已被推荐为各种国家和国际安全流产实践指南中的标准做法。与其他成熟剂如渗透扩张器、其他前列腺素和米非司酮相比，米索前列醇具有许多优势。米索前列醇可通过口服、舌下、阴道、颊和直肠途径给药。与安慰剂相比，用于非妊娠宫颈的宫颈预处理时，米索前列醇的使用已被发现可改善宫颈扩张，减少进一步扩张的需要，并使扩张更容易，而不会出现许多并发症。比较阴道和舌下途径的研究表明，在孕妇中宫颈成熟没有显著差异。我们发现，阴道给予米索前列醇进行宫颈预处理比舌下给予米索前列醇更有效，在小妇科手术前达到更高的基线宫颈扩张，进一步扩张的需要和所需时间减少，尽管两组的扩张难易程度相似。这种阴道给予米索前列醇的效果在绝经前妇女中更为明显。我们的研究结果与其他关于经阴道或舌下给予米索前列醇的研究结果不同，因此必须进行大型多中心研究，就该主题达成共识。
