Significance of Misoprostol-Induced Cervical Ripening Prior to Hysteroscopy

Background Hysteroscopy, a minimally invasive procedure for diagnosing and treating intrauterine pathologies, can be challenging due to inadequate cervical dilation, leading to procedural difficulties and patient discomfort. Misoprostol, a synthetic prostaglandin E1 analog, is increasingly used for cervical ripening to ease hysteroscopic procedures. Objective To evaluate the efficacy and safety of misoprostol for cervical ripening prior to hysteroscopy. Material and methods This prospective study included 539 women who presented to the Gynecology OPD for elective hysteroscopy. Participants were randomly assigned to either Group A (n=300), who received 400 µg misoprostol vaginally at night before hysteroscopy, or Group B (n=239), who had a placebo. The outcomes assessed were cervical dilation, procedural time, patient-reported pain during hysteroscopy, and placement of a copper IUD on post-insertion day 1 as defined by the visual analog score (VAS), incidence of cervical lacerations, or adverse side effects. Results Group A had significantly higher rates of achieving greater cervical dilation compared to Group B. Specifically, 50% of patients in Group A achieved a dilation of 7-8 mm, and 15% achieved dilation greater than 8 mm, whereas only 10% and 5% of patients in Group B achieved these levels of dilation, respectively. The need for additional mechanical dilation was lower in Group A (10% vs. 55%). Procedural times were shorter in Group A, with 75% of procedures taking 10 minutes or less compared to 30% in Group B. Patient-reported pain was also lower in Group A. Conclusion Misoprostol improves cervical ripening before hysteroscopy, reducing the need for mechanical dilation, shortening operation time, and lowering pain levels. Despite moderate side effects, it remains a key preoperative cervical preparation due to its procedural and patient comfort benefits.