Determining the Optimal Time Interval Between Vaginal Dinoprostone Administration and Diagnostic Office Hysteroscopy in Nulliparous Women: A Randomized Double-Blind Trial.

Abstract

STUDY OBJECTIVE\nTo determine optimal timing of vaginal dinoprostone administration before office hysteroscopy (OH) in nullipara.\n\n\nDESIGN\nRandomized double-blinded trial SETTING: Tertiary referral hospital PATIENTS: 180 nulliparous women undergoing diagnostic OH INTERVENTIONS: We randomly allocated women to long-interval or short-interval dinoprostone groups where 3 mg dinoprostone was administered vaginally 12 hours before OH in long-interval group or 3 hours before OH in short-interval group.\n\n\nMEASUREMENTS AND MAIN RESULTS\nThe primary outcome was pain during OH measured by a 100-mm visual analog scale(0=no pain; 100=worst pain imaginable). Secondary outcomes were ease of hysteroscope passage, women satisfaction score, drug side effects. Long-interval dinoprostone had lower pain scores during OH(P <0.001). Contrarily, pain scores 30 minutes postprocedure were similar in both groups(P=0.1). Women were more satisfied, and clinicians found hysteroscope passage through the cervical canal easier and shorter in long-interval dinoprostone group than short-interval group(P<.001&P=0.003 &P<.001, respectively). Side effects were comparable in both study groups.\n\n\nCONCLUSION\nVaginal dinoprostone 12 hours before OH was more effective than vaginal dinoprostone administrated 3 hours before OH in reducing pain during OH in nulliparous patients with easier hysteroscope insertion, shorter procedure duration, and better women satisfaction score.