Current practices and perceptions of misoprostol use for cervical preparation prior to outpatient hysteroscopy: a nationwide survey among gynecologists in Spain.

Background: Although misoprostol has been used as a potential option for cervical priming prior to hysteroscopy, the available scientific evidence regarding its use is not always conclusive. The purpose of this article is to assess the different practices and criteria applied for the use of misoprostol use for cervical preparation in outpatient hysteroscopy without anesthesia among gynecologists across Spain, exploring the need for the corresponding evidence-based guidelines.

Methods: We carried out a cross-sectional study in which a two-step approach survey was conducted. Firstly, an online pilot survey was conducted with a limited sample of 10 professionals from 10 centers to identify initial patterns and gather feedback. Subsequently, a comprehensive online survey was carried out over a larger sample of respondents. The comprehensive survey covered aspects of misoprostol usage, including dosage, timing, indications, safety concerns, and overall perception. The survey design allowed for a thorough examination of existing practices and provided valuable insights to help address the disparities noted in misoprostol use for cervical preparation in outpatient hysteroscopies.

Results: Through the comprehensive online survey, we received response of 102 gynecologists from 54 centers across Spain. The overall results show a considerable variation in misoprostol use prior to hysteroscopy, with 21.57% of respondents not using misoprostol in any case, while a substantial majority (78.43%) use it selectively (68.83%) or consistently (9.8%). When asked about the type of patients, the vast majority (72.55%) use it in postmenopausal nulliparous patients, while its was used considerably less in premenopausal nulliparous patients (35.29%), postmenopausal multiparous patients (22.55%), and premenopausal multiparous patients (3.92%), whereas some choose not to use it in any patients (26.47%). Furthermore, 89.22% of respondents felt that there is a lack of clear criteria on misoprostol use, while 79.41% believed that it is necessary to establish such criteria.

Conclusions: There was a diverse landscape of misoprostol use which underscores the complexity and individual approach to cervical preparation for an outpatient hysteroscopy. Indeed, the findings regarding its application, notably more prevalent among postmenopausal patients, contravene the prevailing body of published evidence. Moreover, a considerable proportion of respondents expressed the need for clear criteria, which emphasizes the importance of evidence-based protocols to guide the optimal use of misoprostol.