The risks of cervical injury or uterine perforation can be significantly reduced by preparing the cervix, i.e. cervical priming, with medication prior to an intervention (IUS insertion, hysteroscopy, or curettage). This has been documented in numerous studies and is now included in all evidence-based guidelines: WHO, RCOG in Great Britain, ANAES in France.
Drug-based priming is recommended for young women in particular, as well as for cervical anomalies, previous operations, or abortions after the first trimester. A routine application is medically reasonable and can be better integrated into the regimen of the practice/clinic than a selective procedure.
If minor dilatation is necessary (IUD/IUS, hysteroscopy):
- Misoprostol (Cyprostol®) – 2 tablets (400mcg) sublingual one hour or oral/vaginal 3 hours before surgery.
- Alternatively, 1 tablet Arthrotec® oral and 1 tablet Cyprostol® sublingual.
- If more dilatation is necessary (St.p. conisation or other operations, St.p. difficult IUD insertion) use Mifepristone (Mifegyne®) – 1 tablet (200mg) oral 24-48 hours before surgery.
- If analgesia is inadequate, possibly additional local anesthesia (intracervical) is needed.