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      Intravaginal isonicotinic acid hydrazide (INH) versus misoprostol for cervical ripening prior to hysteroscopy

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          Abstract

          Objective

          The aim of the present study was to compare the efficacy of vaginal isoniazid (isonicotinic acid hydrazide [INH]) and vaginal misoprostol in cervical ripening before hysteroscopic surgery.

          Methods

          This randomized controlled trial included patients scheduled for hysteroscopic surgery during April 2016 and June 2017. The inclusion criteria were as follows: postmenopausal women or those at premenopausal age who had not had a vaginal delivery and candidate for diagnostic or operative hysteroscopy with closed cervix before intervention. The INH group (intervention group) received 900 mg of vaginal isoniazid (three 300-mg pills) 6–8 hours before hysteroscopic surgery. The misoprostol group (control group) received 400 micrograms of vaginal misoprostol 6–8 hours before hysteroscopic surgery. Finally, the efficacy of the 2 agents was comparatively analyzed.

          Results

          Baseline characteristics were comparable between the groups. In 67 cases in the INH group (95%) and 45 in the misoprostol group (50%), hysteroscopic entry was successful without additional mechanical dilation, and this difference was statistically significant ( P=0.001). The odds ratio (OR) obtained in this study was 0.57 for both INH and misoprostol groups (OR, 0.57; 95% confidence interval, 0.43–0.75). Further, 19 cases in the INH group vs. 45 cases in the misoprostol group did not respond to the intervention, indicating statistically significance ( P=0.001).

          Conclusion

          Vaginal INH is more effective than misoprostol in cervical ripening before hysteroscopic surgery and can be a good alternative to misoprostol.

          Trial Registration

          Iranian Registry Clinical Trial (IRCT) Identifier: IRCT2015112821506N4

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          Most cited references23

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          Catheter-related infections.

          Didier Pittet, Philippe Eggimann, Hugo Sax (2004)
          Nosocomial infections are a leading cause of morbidity and mortality among hospitalized patients. These infections have made newspaper headlines recently in many countries, and both patients and their relatives are now perfectly aware of their existence and of the risks which are inherent to any medical activity. However, significant improvements in the knowledge of the pathophysiology and epidemiology of nosocomial infections allow us to prevent them efficiently. Accordingly, they should no longer be considered as an inevitable tribute to pay to the continuous progress of medicine, but as a real challenge in the process of improving the quality of patient care. This is particularly the case for bloodstream infections, of which at least 80% are considered to be catheter associated. This paper reviews the epidemiology and impact of infections associated with the use of intravenous catheters. Principles of therapy are reviewed, as well as major aspects of prevention.
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            Cervical ripening before operative hysteroscopy in premenopausal women: a randomized, double-blind, placebo-controlled comparison of vaginal and oral misoprostol.

            Cem Batukan, Cagdas Turkyilmaz, Y Sahin … (2008)
            To compare the effectiveness of oral and vaginal misoprostol for preoperative cervical ripening in premenopausal women before hysteroscopic surgery. Placebo-controlled, double blind, randomized trial. University hospital. Eighty-six premenopausal women eligible for operative hysteroscopy were recruited. Nine women were excluded from the study. Patients were randomly assigned to receive 400 microg of misoprostol orally (n = 39) or vaginally (n = 38), 10-12 hours before operative hysteroscopy. Extent of initial cervical width, percentage of patients requiring cervical dilatation, duration of cervical dilatation and surgical procedure, complications during procedure, and associated side effects. Mean cervical widths in the vaginal and oral misoprostol groups after treatment were 7.3 +/- 1.6 mm and 6.0 +/- 1.5 mm, respectively, which was a statistically significant difference. Time required for cervical dilatation (98.6 +/- 88.7 s vs. 49.1 +/- 34.9 s) and duration of surgery (14.5 +/- 6 vs. 7.7 +/- 4.0 min) was statistically significantly shorter in the vaginal misoprostol group. The percentage of women with an initial cervical width of 9 mm was statistically significantly higher in the vaginal misoprostol group (36.8% vs. 5.1%). Uterine perforation occurred in two patients in the oral misoprostol group and in none in the vaginal misoprostol group. Side effects were comparable between the two treatment groups. Vaginal administration of misoprostol is more effective than the oral route for preoperative cervical ripening in premenopausal women.
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              Comparison of real-time ultrasonography, hysterosalpingography, and laparoscopy/hysteroscopy in the evaluation of uterine abnormalities and tubal patency.

              J Randolph, Y K Ying, D B Maier … (1986)
              In a study to assess real-time ultrasonography (US) as an alternative to hysterosalpingography (HSG) in the evaluation of uterine abnormalities and tubal patency, 61 women underwent US immediately before hysteroscopy/laparoscopy. Saline was instilled into the uterus to provide contrast during US. The findings were compared with surgical and preoperative HSG findings. With surgical findings as the standard, US was as accurate (sensitivity 98%, specificity 100%) as HSG (sensitivity 98%, specificity 92%) in demonstrating uterine abnormalities and provided a more complete assessment of the abnormality. US was as accurate (sensitivity 100%, specificity 91%) as HSG (sensitivity 96%, specificity 94%) in demonstrating the presence of tubal patency but less accurate in establishing which tubes were patent. Thus real-time US with fluid instillation provides an accurate alternative to HSG in screening for uterine abnormalities and tubal patency.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Obstet Gynecol Sci
                Journal ID (iso-abbrev): Obstet Gynecol Sci
                Journal ID (publisher-id): OGS
                Title: Obstetrics & Gynecology Science
                Publisher: Korean Society of Obstetrics and Gynecology; Korean Society of Contraception and Reproductive Health; Korean Society of Gynecologic Endocrinology; Korean Society of Gynecologic Endoscopy and Minimal Invasive Surgery; Korean Society of Maternal Fetal Medicine; Korean Society of Ultrasound in Obstetrics and Gynecology; Korean Urogynecologic Society
                ISSN (Print): 2287-8572
                ISSN (Electronic): 2287-8580
                Publication date (Print): July 2020
                Publication date (Electronic): 19 June 2020
                Volume: 63
                Issue: 4
                Pages: 514-520
                Affiliations
                [1 ]Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, Iran
                [2 ]Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Zanjan, Iran
                [3 ]Endometriosis Research Center,Iran University of Medical Sciences, Tehran, Iran
                [4 ]Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
                Author notes
                Corresponding author: Yousef Moradi, PhD Candidate Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran 1449614535, Iran E-mail: yousefmoradi211@ 123456yahoo.com
                Author information
                http://orcid.org/0000-0002-2936-5930
                Article
                Publisher ID: ogs-19170
                DOI: 10.5468/ogs.19170
                PMC ID: 7393750
                PubMed ID: 32550739
                SO-VID: c2b6bf3d-812b-490c-a244-1d8652dee4df
                Copyright © Copyright © 2020 Korean Society of Obstetrics and Gynecology
                License:

                Articles published in Obstet Gynecol Sci are open-access, distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 September 2019
                Date revision received : 1 February 2020
                Date accepted : 16 March 2020
                Categories
                Subject: Original Article
                Subject: General Gynecology

                Keywords: isonicotinic acid hydrazide,misoprostol,cervical ripening
                Data availability:
                Keywords: isonicotinic acid hydrazide, misoprostol, cervical ripening

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