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Determining the Optimal Time Interval between Vaginal Dinoprostone Administration and Diagnostic Office Hysteroscopy
Nansy Mohamed Ali Rund1, Hossam El Shenoufy2, Bassem Aly Islam1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University (Drs. Rund, Islam, and Nassar), Cairo.
Study Objective:
To determine the optimal timing of vaginal dinoprostone administration before office hysteroscopy (OH) in nulliparous women.
Design:
Randomized, double-blind trial.
Setting:
Tertiary referral hospital.
Patients:
A total of 180 nulliparous women undergoing diagnostic OH.
Interventions:
We randomly allocated the women to long-interval or short-interval dinoprostone groups: three mg dinoprostone was administered vaginally 12 hours before OH in the long-interval group and 3 hours before OH in the short-interval group.
Measurements And Main Results:
The primary outcome was pain during OH measured using a 100-mm visual analog scale (0 = no pain; 100 = worst pain imaginable). The secondary outcomes were ease of hysteroscope passage, patient satisfaction score, and drug-related adverse effects. The patients in the long-interval dinoprostone group had lower pain scores during OH (p <.001). Contrarily, pain scores 30 minutes after the procedure were similar in both groups (p = .1). The patient satisfaction score was higher and clinicians found hysteroscope passage through the cervical canal easier and quicker in the long-interval dinoprostone group than in the short-interval group (p <.001, p = .003, and p <.001, respectively). Side effects were comparable in both study groups.
Conclusion:
Vaginal dinoprostone administered 12 hours before OH was more effective than that administered 3 hours before OH in reducing pain during OH in nulliparous women, with easier hysteroscope insertion, shorter procedure duration, and higher patient satisfaction score.
