World Journal of Laparoscopic Surgery, May-August 2008;1(2):20-22 Role of Mechanical Dilatation of Cervix
in Hysteroscopy
Monique Directo Javier

Diplomate of Philippines Obstetrical and Gynecological Society, Cebu, Philippines Abstract
2.7-5 mm; rigid hysteroscopes, from 1-5 mm; and operative Background: Hysteroscopy with sample of the tissue is the gold hysteroscopes can be as large as 8-10 mm.2,3 The diameters of standard in the diagnosing of abnormal uterine bleeding. Operative the telescope prerequisite the dilatation of the cervix to 10- hysteroscopy can then be performed as a therapeutic procedure in 11mm prior to insertion of the instrument. Ideally, hysteroscopy patients presenting with intrauterine abnormalities. Cervical dilatation is performed with minimal or no cervical dilation.3 But this may poses a great challenge particularly in nulligravid, post-menopausal not always be possible because the common complications women and women with cervical stenosis. Difficulties encountered indilating the cervix poses threat to complications such as cervical tears, encountered during the procedure are reported mainly to be creation of false track, hemorrhage and uterine perforation.
related to the difficulty in entering the internal cervical os withthe telescope especially in nulliparous and postmenopausal Objective: The aim of this study is to review the role of mechanical women. Complications reported are cervical tears, creation of dilatation in hysteroscopy using oral and vaginal misoprostol and false passages, and uterine perforation.4 Prevention of cervical injury and uterine perforation during termination of pregnancy Methods: This study involves a retrospective analytical review and has been demonstrated by pre-operative cervical ripening5,6 compares the role of oral and vaginal misoprostol and laminaria and may be achieved either mechanically, such as with osmotic application in achieving cervical ripening before hysteroscopy. Its dilators,7 or biochemically with prostaglandins.8 Misoprostol effects in cervical dilatation as well as the dosing, advantages and side- is a prostaglandin E1 analogue which is commonly used in effects were also reviewed. There were twenty articles included in this obstetrics for induction of abortion and labor as well as study as extracted from electronic databases Cochrane Library, postpartum to control bleeding (Bugaho et al., 1994). Misoprostol Medscape, Highwire Press and Google. Most of the articles assessedthe cervical diameter by the largest number of Hegar dilators that could applied before hysteroscopy has reduced the need for cervical be inserted into the cervix without resistance. Subjective assessments dilatation, facilitated hysteroscopic surgery and minimized of adverse effects and complications were recorded.
cervical complications (Preutthipan and Herabutya, 1999). Onthe other hand, laminaria tents, made from the stems of Laminaria Conclusion: Methods of cervical priming before hysteroscopy lessens japomica (brown seaweed), are attractive natural substances the need of further cervical dilation pre-operatively, lessens the that can cause cervical dilatation with minimal and no systemic complications associated with the entry of the hysteroscope into thecervical os and offered acceptable side effects.
side effects. They have been shown to be effective in inducingcervical priming prior to operative hysteroscopy (Ostrzenski, INTRODUCTION
1994). The aim of this work is to review several studies of therole of cervical dilatation in hysteroscopy.
Recent advances in fiberoptics, light sources, high resolutionlenses, and endoscopic surgical instrumentation made hysteroscopy an important diagnostic tool as well as therapeutic There were 19 reported randomized controlled trials that tool for patients presenting with intrauterine diseases.
evaluated the efficacy of misoprostol on cervical ripening in Hysteroscopy permits direct visualization of the uterine cavity gynecologic patients, after searching medical literature thus making it the gold standard in diagnosing abnormal uterine databases including Cochrane Library, Medscape, High wire bleeding. Operative hysteroscopy as well has gained popularity Press and Google. One article evaluated the efficacy of laminaria as a minimally invasive approach to intrauterine lesions (Siegler tents. The search terms used included “mechanical cervical and Valle, 1988). However, a systematic review of diagnostic dilation”, “cervical ripening” and “hysteroscopy.” References hysteroscopy in more than 26,000 women reported a failure rate from identified publications were manually searched and cross- of 4.2% for ambulatory hysteroscopy and 3.4% for in-patient referenced to identify additional relevant articles. The studies procedures. Failed procedures were mainly attributed to have shown different cervical responses and outcomes.9-28 technical problems, including cervical stenosis, anatomic and Most of the studies compared the effect of misoprostol against structural abnormalities and pain and intolerance.1 Flexible placebo on different groups of women, such a nulliparous women hysteroscopes used in this procedure range in diameter from and postmenopausal women. Patients received misoprostol Role of Mechanical Dilatation of Cervix in Hysteroscopy either orally or vaginally. The dosages given in the studies REFERENCES
varied from 200 and 1000 mcg given between 2-24 hours before 1. Clark TJ, Volt D, Gupta JK, Hyde C, Song F, Khan KS.
the surgery, via oral, sublingual or vaginal route. One of the Accuracy of hysteroscopy in the diagnosis of endometrial cancer studies compared the effect of laminaria tents against placebo.
and hyperplasia: a systematic quantitative review. JAMA. 202; The patients were randomly assigned into two groups. They underwent hysteroscopic procedure with a 5-10 mm 2. American College of Obstetricians and Gynecologists. ACOG hysteroscope during the follicular phases of their cycle. The Technology assessment in obstetrics and gynecology, number cervical width was assessed by the largest number of Hegar 4, August, 2005: hysteroscopy. Obstet Gynecol. 2005; 106: dilators that could be inserted into the cervix without resistance.
Subjective assessment of the ease of the dilatation to 9 mm by 3. Guido R. Stovall D Hysteroscopy Version 14.3. Uptodate (cited the surgeon was also recorded. Adverse effects like pre- operative pain, mild lower abdominal pain and slight vaginal 4. Bradley LD. Complications in hysteroscopy: prevention, treatment, and legal risk. Curr Opin Obstet Gynecol 2002; 14:409-15.
5. Grimes DA, Schulz KF, Cates WJ Jr. Prevention of uterine DISCUSSION
perforation during curettage abortion. JAMA 1984; 251: 2108- Recently, hysteroscopy has been used to investigate women presenting with abnormal uterine bleeding (Nagele et al, 1996).
6. Schulz KF, Grimes DA, Cates W. Measures to prevent cervical injury during suction curettage abortion. Lancet 1983; 1: Hysteroscopy plus sampling the endometrial tissue increased the sensitivity and specificity for the detection of endometrial 7. Lichtenberg ES. Complications of osmotic dilators. Obstet pathology when compared with blind endometrial biopsy alone.
However, difficulty in cervical dilatation has been one of the 8. Blanchard K, Clark S, Winikoff B, Gaines G, Kabani G, Shannon major causes of failure of this procedure (Scottish Hysteroscopy C. Misoprostol for women’s health. Obstet Bynecol 2002; 99: Audit Group, 1995). The articles reviewed showed that vaginal misoprostol applied pre-operatively facilitates cervical priming 9. Yu D, Li T-c, Xia E, Huang X. A prospective, randomized, and reduced the need for cervical dilation, facilitated the ease controlled trial comparing vaginal misoprostol and osmotic dilator of diagnostic and operative hysteroscopy and minimized cervical in achieving cervical ripening before operative hysteroscopy.
complications. One article mentioned that both misoprostol and Gynecological Surgery 2006; 3: 186-89.
laminaria were equally effective. Nevertheless, misoprostol is 10. Aslan G, Yuce MA, Gucer F. A comparison of vaginal and oral routes in misoprostol administration for cervical priming before superior over the laminaria due to easy application, cheap cost hysteroscopy: a prospective randomized double-blind study.
and convenience and better acceptability to the patient. Both Jinekoloji Ve Obstetrik Dergisi 2004; 18: 145-49.
oral and vaginal misoprostol showed no significant difference 11. Fung TM, Lam MH, Wong SF, Ho LC. A randomized placebo- with respect to cervical opening, duration of dilation as well as controlled trial of vaginal misoprostol for cervical priming before the rate of complications. Most studies of dosing have involved hysteroscopy in postmenopausal women. BJOG 2002; 109; the use of vaginal misoprostol administration with dosages of 200 microgram to 400 microgram given 9-12 hours before 12. Thomas JA, Leylans N, Durand N, Windrim RC. The use of oral hysteroscopy showing the greatest benefit. One review showed misoprostol as a cervical ripening agent in operative that misoprostol application is safe and effective for cervical hysteroscopy: a double blind, placebo controlled trial. Am J priming against placebo in premenopausal women but not in postmenopausal women. Misoprostol is a drug used for the 13. Preutthipan S, Herabutya Y. A randomized controlled trial of vaginal misoprostol for cervical priming before hysteroscopy.
treatment of peptic ulcer disease. The cost is cheap, self- administration is easy and does not require hospital resources 14. Ngia SW, Chan YM, Liu KL, Ho PC. Oral misoprostol for in application, other than information.
cervical priming in non-pregnant women. Hum Reprod 1997;12: 2373-75.
15. Preutthipan S. Herabutya Y. Vaginal misoprostol for cervical priming before operative hysteroscopy, a randomized controlled In conclusion, methods of cervical priming and dilation before trial. Obstet Gynecol 2000; 96: 890-94.
hysteroscopy negate the need of further dilating the cervix at 16. Fernandez H, Alby JD, Tournox C, Chauveaud-Lambling A, de the operation theater prior to the procedure. Among the methods Tayrac R, Frydman R, et al. Vaginal misoprostol for cervical offered in the market, misoprostol is highly superior in the ripening before operative hysteroscopy in premenopausal cervical ripening before hysteroscopy due to cheap cost, easy women: a double-blind, placebo controlled trial with three dose regimens. Human Reprod 2004; 19: 1618-21.
17. Darwish AM, Ahmad AM, Mohammad AM. Cervical priming 23. Bunnasathiansri S, Herabutya Y, O-Prasertsawat P. Vaginal prior to operative hysteroscopy: a randomized comparison misoprostol for cervical priming before dilatation and curettage of laminaria versus misoprostol. Hum Reprod 2004; 19: in post-menopausal women; a randomised controlled trial. J Obstet Gynaecol Res 2004; 30: 221-25.
18. Atay V, Duru NK, Pabuccu R, Ergun A, Tokac G, Aydin BA.
24. Barcaite E, Bartusevicius A, Railaite DR, Nadisaukiene R. Vaginal Vaginal misoprostol for cervical dilatation before operative office misoprostol for cervical priming before hysteroscopy in hysteroscopy. Gynael Endoscopy 1997; 6: 47-49.
perimenopausal and postmenopausal women. Int J Gynaecol 19. Ngai SW, Chan YM, Ho PC. The use of misoprostol prior to hysteroscopy in post-menopausal women. Hum Reprod 2001; 25. Choksuchat C, Cheewadhadnaraks S, Getpook C, Wootipoom V, Dhanavoravibul K. Misoprostol for cervical ripening in non-pregnant women: a randomized double-blind controlled trial of 20. Perrone JF, Caldito G, Mailhes JB, Tucker AN, Ford WR, London oral versus vaginal regimens. Hum Reprod 2006; 21: 2167-70.
SN. Oral misoprostol before office endometrial biopsy. Obstet 26. Oppegaard KS, Nesheim B-I, Istre O, Qvigstad E. Comparison of self-administered vaginal misoprostol versus placebo for 21. Thomas JA, Leynard N, Durand N, Windrim RC. The use of cervical priming prior to operative hysteroscopy using a oral misoprostol as a cervical ripening agent in operative sequential trial design. BJOG 2007; 114: 769.
hysteroscopy; a double blind placebo controlled trial. Am J 27. Crane JM, Healy S. Use of misoprostol before hysteroscopy: a systematic review. J Obstet Gynaecol Can 2006; 28: 373-79.
22. Bisharah M, Al fozan H, Tulandi T. a randomized trial of 28. Darwish AM, Ahmad AM, Mohammad AM. Cervical priming sublingual misoprostol for cervical priming before hysteroscopy.
prior to operative hysteroscopy: a randomized comparison of J Am Assoc Gynecol Laparosc 2003; 10: 390-91.
laminaria versus misoprostol. Hum Reprod 2004; 19: 2391-94.

Source: http://www.worldjls.org/Journal/vol/vol2/05.pdf

Microsoft word - journal of excellence issue no 9.doc

Making the Impossible, Possible, Within a Relationship: An Interview with Lisa and Mike Terry Orlick , Canada Lisa and Mike dedicated their life's efforts towards the pursuit of excellence. Lisa trained at very high levels in gymnastics (state champion as a child), dance (professional ballet, jazz), and acting. Mike’s educational efforts had been aligned with studying and living a li

Update 081029 cd update 17

Chronic Disease Update 17 30 October 08 Please note: for all attachments visit: http://newsletters.gpqld.com.au//index.php?action=view&view=38720 NEWS Joke of the Week Nursing Home Did you hear that nursing homes are starting to give Viagra to the old men living there? It's to keep them from rolling out of bed. Moving Ahead. Report of the 2006-2007 Annual Survey of Divisions

© 2010-2017 Pharmacy Pills Pdf