Cervical priming – pharmacological preparation of the cervix – before a procedure (IUD fitting, hysteroscopy or curettage) significantly reduces the risk of injury to the cervix or perforation of the uterus. This has been documented in many studies and is now included in all “Evidence based Guidelines”: World Health Organization, Royal College of Obstetricians and Gynaecologists in Great Britain, Haute Autorité de Santé in France.
Medical priming is particularly recommended in young women, as well as in the presence of cervical anomalies, previous operations or in terminations after the first trimester.
Routine use makes sense medically and is easier to integrate into the procedures of the surgery/clinic than a selective approach.
- When a little dilation is required (IUD/IUS, hysteroscopy):
Misoprostol (Cyprostol®) 2 tablets (400mcg) under the tongue one hour or orally/vaginally three hours before the procedure. Alternatively 1 tablet of Arthrotec® orally and 1 tablet of Cyprostol® under the tongue.
- When larger dilation is required (S/P conization or other operations, S/P difficult IUD fitting):
Mifepriston (Mifegyne®) 1 tablet (200mg) orally 24-48 hours before the procedure.
– Additional intracervical local anaesthetic if analgesia is insufficient.