Role of Misoprostol on Type 3 Transformation Zone of The Cervix During Colposcopic Examination
Abstract
Background: Complete visualization of the cervical transformation zone (TZ) is essential for accurate colposcopic assessment, as most cervical precancerous lesions arise from this area. Type 3 transformation zone, in which the squamocolumnar junction is not fully visible, represents a common challenge and may increase the risk of missed cervical lesions. Misoprostol, a prostaglandin E1 analogue, has been suggested as a simple method to improve TZ visibility through cervical ripening. This study aimed to assess the efficacy of vaginal misoprostol in improving transformation zone visibility during cervical cancer screening.
Methods: This prospective interventional study was conducted at Zagazig University Hospitals on 23 women aged ≥35 years with Type 3 transformation zone. All participants received a single intravaginal dose of misoprostol (400 μg), and colposcopy was repeated after 4 hours to assess transformation zone conversion. Colposcopic evaluation included inspection after normal saline, application of 5% acetic acid, and Lugol’s iodine. Colposcopy-directed biopsies were taken from suspicious lesions and sent for histopathological examination.
Results: The mean age of participants was 49.7±8.6 years (range 35–65), and the mean parity was 3.5±1.6 (range 1–6). Vaginal discharge was the most common presenting complaint (43.4%), followed by contact bleeding (30.4%). Following misoprostol administration, successful conversion of Type 3 TZ to Type 1 or Type 2 was achieved in 19 women (82.6%), while 4 women (17.4%) showed no conversion. Acetowhite lesions were detected in 78.3% of cases. Misoprostol was generally well tolerated; 52.2% of participants reported no side effects, and mild cramping was the most frequent complaint (34.8%). Biopsies were obtained in 19 cases (69.6%), revealing chronic cervicitis in 68.4% and CIN 1 in 31.6%, with no high-grade lesions detected.
Conclusion: A single intravaginal dose of misoprostol (400 μg) appears to be an effective and well-tolerated method for improving transformation zone visibility in women with Type 3 TZ during colposcopy. This approach may enhance colposcopic evaluation and facilitate directed biopsy in cases with suspected cervical pathology.