Acomparative study between isosorbide mononitrate (IMN) versus misoprostol prior to hysteroscopy

Objective: To compare the efficacy of a nitric oxide donor (isosorbide mononitrate) and a prostaglandin E1 analogue (misoprostol) for cervical priming before hysteroscopy. Design: Comparative clinical trial. Methods: A total of 162 patients with diagnosed intrauterine lesions scheduled for hysteroscopy were allocated to two groups: in group A patients (n = 81) IMN 40 mg was inserted into the posterior fornix of the vagina while misoprostol 200 mu g was inserted into the posterior fornix of the vagina in group B patients (n = 81). Results: There was no significant difference between IMN and misoprostol with regard to the duration of application or difficult dilatation. In contrast, there was a significant difference between IMN and misoprostol with regard to baseline cervical dilatation (5 mm for IMN and 8 mm for misoprostol) and duration of dilatation (73 s for IMN and 49 s for misoprostol). There was no significant difference between IMN and misoprostol with regard to nausea, vomiting and hot flushes. In contrast, there was a significant difference between IMN and misoprostol with regard to abdominal pain (17 cases for IMN and 55 cases for misoprostol) and headache (65 cases for IMN and 9 cases for misoprostol). Conclusion: Misoprostol is superior to isosorbide mononitrate regarding better baseline cervical dilatation, less duration of dilatation, less incidence cervical injury and finally better feasibility of the procedure. (C) 2010 Middle East Fertility Society. Production and Hosting by Elsevier B.V. All rights reserved.