Objective: To compare the efficacy of Dinoprostone gel versus intravaginal evening primrose oil capsule as cervical ripening agents for operative hysteroscopy…. and to compare the length of time to achieve a 10mm cervical dilatation prior to operative hysteroscopy. Methods: This is a two-arm randomized controlled trial done in a tertiary training institution. Group A and B received Dinoprostone gel and EPO for cervical ripening, respectively. Population consisted of women admitted for operative hysteroscopy, aged between 19-56 years old, and with closed cervix. Results: Thirty-eight (38) patients mostly pre-menopausal with mean age of 41, without history of uterine surgery, and presented with abnormal uterine bleeding, were included. Significant difference was observed in initial cervical dilatation between Dinoprostone gel(5.63 mm) versus EPO(4.21mm). Most patients in EPO group were pain-free while Dinoprostone group experienced tolerable pain. Use of Dinoprostone was 4x more expensive versus EPO. Conclusion Both agents were effective in dilating the cervix prior to operative hysteroscopy. Nevertheless, EPO may be superior and acceptable due to reduced cost, patient convenience and acceptability, and ease of administration.
Dinoprostone

OBJECTIVES: To compare the efficacy of Luminaria versus Evening Primrose Oil as cervical ripening agent prior to operative hysterectomy.

MATERIALS AND METHODS: A randomized controlled trial carried out in a university hospital from April to August 2015. The Luminaria group patients received a single intracervical Laminaria tent (2-3 mm in diameter) 12 hours prior to the hysteroscopic procedure. The Evening Primerose Oil group of patients received 6 intravaginal Evening Primerose Oil capsules inserted into the posterior fornix 6 hours prior the procedure followed by another 4 capsules inserted 1 hour prior to the procedure.

RESULTS: Both Laminaria and Evening Primerose Oil were effective in dilating the cervix, but the initial cervical dilation was significantly greater for the Laminaria group. The median duration of time needed to insert the 10mm Hegar's dilator was significantly longer for the Laminaria tent group, compared to the Evening Primerose Oil group (123 seconds s 55 seconds, P-value 0.01). The ease of cervical dilation was likewise significantly better for the Evening Primerose Oil group (26.19% vs 16.67%, P-value 0.04).

CONCLUSION: Both Evening Primerose Oil and Laminara were effective in dilating the cervix. However, Evening Primerose Oil resulted in easier and faster cervical dilation required for hysterectomy. Evening Primerose Oil had better patient acceptability because it was more convenient and easier to use, and is less expensive, compared to Laminaria tents. Therefore , Evening Primerose Oil capsules is an easy-to-use regimen that can be recommended for patients undergoing operative hysterectomy, to facilitate easier and faster cervical dilation, and reduce compilations associated with resectoscope entry.

Human ; Female ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Hysterectomy-general Surgery ; ; Laminaria ; ; Hysterectomy ; Cervix Uteri

One in 300 to 4500 infants is born with abnormalities of the external genitalia and Mixed Gonadal Dysgenesis is the second most common cause. This is a case of a 12-year old child, raised as male and diagnosed to have ambiguos genitalia at birth. Analysis showed a mosaic karyotype, one cell line with 45 chromosomes including a Monosomy X and a second cell line showed a normal 46, XY karyotype. A thorough evaluation by a multidisciplinary team composed of a reproductive endocrinologist, pediatric gynecologist, pediatric urologist, pediatric endocrinologist, geneticist and child psychiatrist was made. The patient underwent pre-operative diagnostic cystourethroscopy and genitoscopy, total laparoscopic hysterectomy with bilateral gonadectomy and first stage repair of hypospadia. Laparoscopic management was the best approach for this patient because it provided minimally invasive surgery for children and enabled all necessary procedures, including evaluation, biopsy, and gonadectomy, for diagnosis d treatment.

Human ; Male ; Child: 6-12 Yrs Old ; Gonadal Dysgenesis, Mixed ; ; Hysterectomy ; ; Laparoscopy ; Genitalia

Materials and Methods: A randomized controlled of trial carried out in a university hospital from April to August 2015. The Laminaria group patients received a single intracervical Laminaria tent (2-3 mm in diameter) 12 hours prior to the hysteroscopic procedure. The Evening Primrose Oil group of patients received 6 intravaginal Evening Primrose Oil capsules inserted into a posterior fornix 6 hours prior to the procedure followed by another 4 capsules inserted 1 hour prior to the procedure.

Results: both Laminaria and Evening Primrose Oil were effective in dilating the cervix, but the initial cervical dilation was significantly greater for the Laminaria group. The median duration of time needed to insert the 10mm Hegar's dilator was significantly longer for the Laminaria tent group, compared to the Evening Primrose Oil group (123 seconds vs 55 seconds, P-value 0.01). The ease of cervical dilation was likewise significantly better for the Evening Primrose Oil group (26.19% vs 16.67%, P-value 0.04).

Conclusion: Both Evening Primrose Oil and Laminaria were effective in dilating the cervix. However, Evening Primrose Oil resulted in easier and faster cervical dilatation required for hysteroscopy. Evening Primrose Oil had better patient acceptability because it was more convenient and easier to use, and is less expensive, compared to Laminaria tents. Therefore, Evening Primrose Oil capsules is an easy-to-use regimen that can be recommended for patients undergoing operative hysteroscopy, to facilitate easier and faster cervical dilatation, and reduce complications associated with resectoscope entry.

Human ; Operative Hysteroscopy ; Cervical Priming ; Laminaria Tents ; Evening Primrose Oil

Congenital cervical dysgenesis is a rare mullerian anomaly occurring in 1 in 80,000 to 100,000 births and is thought to arise primarily from a defect in the elongation of the mullerian ducts. For decades, standard gynecologic practice for these patients has been the removal of the uterus to relieve the obstruction and conservative management is still a matter of debate. Presented here is a 17-year-old, nulligravid with congenital cervical dysgenesis who successfully underwent cervical canalization and cervico-vaginal anastomosis in a tertiary training institution. One month after surgery, the patient had normal menses and has been pain-free up to present. This paper concludes that a thorough investigation of patients with this anomaly is imperative and conservative management in carefully selected patients should be applied as first-line treatment option.

Human ; Female ; .