Dilapan-S versus vaginal misoprostol for cervical preparation before diagnostic hysteroscopy: a prospective randomized controlled trial

ABSTRACT

Objective. The difficulty entering the cervix accounts for almost half of all hysteroscopy complications. Proper preparation of the cervix before hysteroscopy can reduce these difficulties. Our study aimed to compare the effectiveness of Dilapan-S versus vaginal misoprostol in preparing the cervix to make diagnostic hysteroscopy procedures easier.
Patients and Methods. We conducted a prospective randomized controlled clinical trial in Ain Shams University Hospital. A total of 80 cases were assigned into two equal groups: Dilapan-S was inserted intracervical 4 hours before the hysteroscopic procedure. In contrast, 400 mcg of misoprostol was inserted into the posterior vaginal fornix 4 hours before the procedure in group II. Primary outcome measure(s): Ease of cervical entry (Likert scale), procedural time, and pain scoring (visual analog scale).
Results. A total of 80 cases were assigned at random to the following groups: Dilapan-S dilation (n = 40) and 400-mcg Misoprostol dilation (n = 40), with no statistically significant difference between the two groups regarding age, body mass index (BMI), parity, complaint, and pain score (VAS-10). The ease of cervical entry in the Dilapan-S group was higher than the misoprostol group (4.0 ± 0.0 vs 3.0 ± 1.0, p = 0.006) with lower procedure duration among Dilapan-s group compared to the misoprostol group (47 ± 8 vs 95 ± 14, p < 0.001).
Conclusions. The synthetic osmotic dilator (Dilapan S) better facilitates ripening of the cervix and dilatation with less incidence of nausea, vomiting, and abdominal pain than vaginal misoprostol before diagnostic hysteroscopy.