Archives of Gynecology and Obstetrics

, Volume 298, Issue 1, pp 133–137 | Cite as

Effect of cervical priming with misoprostol on cervical entry in women undergoing vaginoscopic hysteroscopy for evaluation of abnormal uterine bleeding: a randomized controlled trial

  • B. Nandhini
  • Dilip Kumar Maurya
  • Anish Keepanasseril
  • N. S. Kubera
General Gynecology



To study the effect of cervical priming with misoprostol on cervical entry in women undergoing diagnostic hysteroscopy for evaluation of abnormal uterine bleeding.


Randomized controlled trial conducted in teaching hospital and tertiary referral center on 122 women requiring diagnostic hysteroscopy for evaluation of abnormal uterine bleeding. Women were randomized into two equal groups (n = 122). Study group received 200-μg vaginal misoprostol, 3 h prior to vaginoscopic hysteroscopy. No drug was used in control group. No analgesia or anesthesia was used in either group. Outcome measure included (i) ease of cervical entry (Likert scale), and (ii) pain scoring (Visual Analog Scale) and procedural entry time.


Forty-six (75.41%) patients in the study group and 17 (27.87%) in control group had easy or very easy entry (Likert scale-4 and 5) (p < 0.001). Median pain scoring by VAS and the median procedural entry time was significantly lower in the study group compared to the control group (p < 0.001).


Use of 200-μg vaginal misoprostol, administered vaginally 3 h before diagnostic vaginoscopic hysteroscopy, was found to be simple and effective method of cervical priming in facilitating cervical entry with minimal side effects.

Clinical Trial registry of India (CTRI): (CTRI/2015/04/005666) (website:


Cervical priming Ease of cervical entry Misoprostol Vaginoscopic hysteroscopy 


Author contributions

DKM: involved in designing, writing the draft, and approved the final version. NB: involved in designing, collection, and revision of the manuscript. AK: designed the study, analysis, reviewed, revised, and approved the manuscript. NSK: involved in designing and revision of the manuscript.

Compliance with ethical standards

Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

All procedures performed in this study were done with the ethical standards set by the Institute Scientific Advisory and Ethical committee (Human Studies), in accordance with the 1964 Helsinki declaration and its later amendments. Study was approved by the Institute Ethics Committee (Human Studies), JIPMER, Puducherry, India (JIP/IEC/2014/8/403).

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • B. Nandhini
    • 1
  • Dilip Kumar Maurya
    • 1
  • Anish Keepanasseril
    • 1
  • N. S. Kubera
    • 1
  1. 1.Department of Obstetrics and GynecologyJawaharlal Institute of Post-graduate Medical Education and Research (JIPMER)PondicherryIndia

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