Oral misoprostol versus placebo for cervical dilatation before vacuum aspiration in first trimester pregnancy

Abstract

Intravaginal misoprostol has been shown to be effective for cervical priming before a surgically induced abortion. The objective was to investigate the effectiveness of oral misoprostol in cervical dilatation prior to vacuum aspiration between the 6th and 12th weeks of pregnancy. The results showed that in nulliparous patients, the median cervical dilatation in the treatment group (7.8 mm) was significantly greater than that in the placebo group (3.7 mm). In multiparous patients, the difference was also statistically significant (9.8 versus 6.0 mm). The ease of dilatation, assessed subjectively by the operating surgeons, was significantly improved in the treatment group. There was also a significant reduction in the duration of the operation and in the mean blood loss in the treatment group. The side-effects encountered in the treatment group were mild and well accepted by the women. Oral misoprostol is an effective and safe method for cervical dilatation prior to vacuum aspiration in first trimester pregnancy.

PIP: The effectiveness of oral misoprostol for cervical dilatation prior to first-trimester (6-12 weeks of pregnancy) vacuum aspiration was evaluated in a case-control study of 75 women referred to a Hong Kong clinic for induced abortion. 36 women were randomly assigned to receive misoprostol (400 mcg 12 hours before the procedure), while 39 women were given a placebo; 21 women in the treatment group and 22 controls were nulliparous. Among nulliparous women, median cervical dilatation was significantly greater in the treatment group (7.8 mm) than the placebo group (3.7 mm). In multiparous women, these medians were 9.8 and 6.0 mm, respectively. The ease of further dilatation, subjectively assessed by operating surgeons, was rated easier than normal in 88% of women in the treatment group compared with 26% of controls. There was also a significant reduction in the median duration of vacuum aspiration in nulliparous cases (4.5 minutes) compared with controls (5.5 minutes) and in median blood loss (20 and 28 ml, respectively). Side effects (lower abdominal pain, vaginal spotting, nausea) were mild and well-tolerated in both groups. These findings suggest that oral misoprostol is a safe, cost-effective (US$0.40 per tablet) alternative for cervical priming prior to vacuum aspiration.