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Postmenopausal cervical ripening.

Cervical ripening is usually thought of in the context of pregnancy. Enhancing cervical dilatation prior to uterine evacuation or the induction of labour is well documented, but little is known about 'ripening' in postmenopausal women.

When access is required to the uterus to investigate pathology via a hysteroscope, cervical dilatation is desirable to allow the atraumatic passage of a 10 mm diameter operating instrument. Damage from a grasping volsellum or tenaculum to the anterior lip or forcible expansion with Hegar dilators to the cervical canal can be reduced by pre-operative preparation. Oppergaard et al. from Denmark (BJOG 2010; 117: 53-61) studied the use of misoprostol prior to hysteroscopic evaluation in postmenopausal women. All the patients were undergoing endometrial investigation and had received 2 weeks of treatment with 25 ug of vaginally delivered oestradiol. They were then allocated to 1 000 ug misoprostol or placebo. The operators were blind to the immediate pre-treatment, which was self-administered by the patients the evening before.

The misoprostol was effective in that it allowed less force to be used in dilating the cervix. The method was acceptable to the patients, it is cheap, and there were minimal side-effects.

Athol Kent


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Title Annotation:THE BEST OF THE REST: A summary of some of the best recent landmark articles from the international journals
Author:Kent, Athol
Publication:South African Journal of Obstetrics and Gynaecology
Article Type:Brief article
Geographic Code:6SOUT
Date:Apr 1, 2010
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