Sublingual Misoprostol for Unsatisfactory Colposcopic Finding: A randomized controlled trial
Article Sidebar
Main Article Content
Abstract
Objective: To assess the effectiveness of 200 µg sublingual misoprostol for converting an unsatisfactory to satisfactory colposcopic finding.
Materials and methods: Forty-two participants with abnormal cervical cytology and unsatisfactory colposcopic finding who underwent colposcopy between September 2016 and June 2017 were randomized into two groups; either misoprostol or placebo given sublingually. Second a colposcopy was performed 2 hours later, and the conversion rate of unsatisfactory to satisfactory colposcopic finding of both groups was analyzed.
Results: Baseline characteristics were similar between two groups. Conversion rate of unsatisfactory to satisfactory colposcopic finding in participants who received sublingual misoprostol was statistically significant higher than placebo group ( 80.9% VS 38.1%, p = 0.011, RR = 2.1, 95% CI 1.18-3.80). There was no significant difference in adverse effect between groups.
Conclusion: Two hundred micrograms of sublingual misoprostol, 2 hours before performing colposcopy can convert an unsatisfactory finding to a satisfactory one.
Keywords: unsatisfactory colposcopy, abnormal pap smear, sublingual misoprostol
Article Details
References
2. Sankarnarayan R, Budukh A, Rajkumar R. Effective screening programmes for cervical cancer in low and middle income developing countries. Bull World Health Organ 2001;79:954–62.
3. Apgar BS, Brotzman GL, Splitzer M. Colposcopy, principles and practice: An integrated textbook and atlas. 1st ed. Philadelphia: W.B. Saunders Company; 2002. p115–82.
4. Rome RM, Chanen W, Ostor AG. Preclinical cancer of the cervix: diagnostic pitfalls. Gynecol Oncol 1983;22:302–20.
5. Sellors JW, Sankaranarayanan R. Colposcopy and treatment of cervical intraepithelial neoplasia: A beginners’ manual. International agency for research on cancer. Lyon: IARC Press 2003;89–94.
6. Martin-Hirsch PP, Paraskevaidis E, Bryant A, Dickinson HO, Keep SL. Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev 2010;CD001318.
7. Preutthipan S, Herabutya Y. A randomized controlled trial of vaginal misoprostol for cervical priming before hysteroscopy. Obstet Gynecol 1999;94:427-30.
8. Preutthipan S, Herabutya Y. A randomized comparison of vaginal women before operative hysteroscopy. Fertil Steril 2006;86:990-4.
9. Aggarwal R, Suneja A, Agarwal N, Mishra K. Role of misoprostol in overcoming an unsatisfactory colposcopy: a randomized double-blind placebo-controlled clinical trial. Gynecol Obstet Invest 2006;62:115–20.
10. Thanapprapasr D, Wilailak S, Israngura Na, Ayudhya N, Lertkhachonsuk A, Likittanasombut P, et al. Can vaginal misoprostol effectively increase rate of a satisfactory colposcopy: a randomized double-blind placebo-controlled trial. Japanese Journal Clinical Oncology 2010;40:203–7.
11. Makkar B, Batra S, Gandhi G, Zutshi V, Goswami D. Vaginal misoprostol versus vaginal estradiol in overcoming unsatisfactory colposcopy. Gynecol Obstet Invest 2014;77:176–9.
12. Tungmunsakulchai R, Sripipattanakul M. Misoprostol versus placebo for unsatisfactory colposcopic finding: a randomized controlled trial. Thai J Obstet Gynaecol 2010;18:134-8.
13. Saav I, Kallner H K, Fiala C, Danielsson K G. Sublingual versus vaginal misoprostol for cervical dilatation 1 or 3 hour prior to surgical abortion: a double blinded randomized controlled trial. Human Reproduction 2015;30:1314-22.
14. Aronsson A, Fiala C, Stephansson O, Granath F, Schweer H, Gemzell-Danielsson K. Pharmacokinetic profiles up to 12 h after administration of vaginal, sublingual and slow-release oral misoprostol. Hum Reprod 2007;22:1912-8.
15. Aronsson A, Helstrom L, Gemzell-Danielsson K. Sublingual compared with oral misoprostol for cervical dilataion prior to vacuum aspiration: a randomized comparison. Contraception 2004;69:165-9.