الفهرس 
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Abstract
Summary : Office hysteroscopy is a crucial tool in the diagnosis and treatment of different pathologies in the uterine cavity including infertility, abnormal uterine bleeding and intrauterine masses. failed hysteroscopy occurs when hysteroscope cannot pass through the cervical canal, such case is more common in nulliparous and post-menopausal women due to cervical stenosis. Several techniques could be used to negotiate cervical stenosis such as applying pharmacological dilatation, mechanical dilatation, hygroscopic dilatation and hydrodilatation. Misoprostol could be used as a pharmacological agent for priming the cervix . Routes of administration of misoprostol can be orally, vaginally or rectally. Previous studies indicated route-dependent pharmacokinetics of misoprostol which showed controversy regarding its optimum efficacy. The aim of our study was to compare between the effect of vaginal and sublingual misoprostol for cervical priming before office hysteroscopy. Our study is a double blind randomized controlled study that included 48 patients who were designed to administer misoprostol sublingually before office hysteroscopy and were labelled as sublingual group and 52 patients who were assigned to administer misoprostol vaginally prior to office hysteroscopy and were labelled as vaginal group. They were recruited and assessed for eligibility and grouped as patient group at the outpatient Clinic of the obstetrics and gynecology department at Mansoura University hospitals. Our results indicated no statistically significant difference between sublingual and vaginal groups regarding age (P value=0.988) and BMI (P value=0.28). Our results revealed no statistically significant difference between sublingual and vaginal groups regarding gravidity (P value=0.228), parity (P value=0.645), previous mode of delivery (P value=0.604) and previous D&C (P value=0.501). Our results indicated no statistically significant difference between sublingual and vaginal groups regarding the indications for hysteroscopy including AUB, pelvic pain, post-operative, primary or secondary infertility, recurrent pregnancy loss, missed IUD or combinations of indications (P value=0.195). Regarding that requirement of dilatation, our results revealed no statistically significant difference between both sublingual and vaginal groups (P value = 0.439). Regarding pain score, our results showed no statistically significant difference between sublingual and vaginal groups (P value = 0.333). Our results demonstrated that no statistically significant difference between the sublingual and vaginal groups regarding patient acceptability (P value = 0.927) and ease of entry by physician (P value = 0.973). However, our results indicated higher incidence of complications between sublingual group which was statistically significant different when it compared with vaginal group (P value=0.013). Regarding the incidence of failed hysteroscopy, our results showed no statistically significant difference between sublingual and vaginal groups (Pvalue = 1.0).