A randomized study comparing the use of sublingual to vaginal misoprostol for pre-operative cervical priming prior to surgical termination of pregnancy in the first trimester

Abstract

Background: Misoprostol is an effective agent for pre-operative cervical priming before surgical termination of pregnancy in the first trimester. Previous studies have shown that both oral and vaginal routes are equally effective for such a purpose. This study aimed to compare a new route of sublingual administration to the vaginal route of administration for pre-operative cervical priming in first trimester surgical abortion. Methods: Eighty women with gestational age <12 weeks were randomized by a computer-generated model to receive 400 μg of misoprostol either sublingually or vaginally 3 h prior to vacuum aspiration. The primary outcome measure was the degree of cervical dilatation, and secondary outcomes included the force required to dilate the cervix from 3 to 8 mm, intra-operative blood loss and incidence of pre-operative side-effects. Results: There was no significant difference in the baseline cervical dilatation (sublingual: 7.6 ± 1.3 mm; vaginal: 7.7 ± 0.73 mm), cumulative force required to dilate the cervix from 3 to 8 mm (sublingual: 9.0 ± 9.8 N; vaginal: 6.6 ± 5.4 N) and total blood loss (sublingual: 52.1 ± 20.2 ml; vaginal: 48.3 ± 12.3 ml). Pre-operative side-effects were also similar. Conclusions: Both sublingual and vaginal misoprostol are effective in cervical priming before surgical termination of pregnancy in the first trimester. Sublingual misoprostol has the advantage of being more convenient to administer and may be more suitable for day surgery. © European Society of Human Reproduction and Embryology 2004; all rights reserved.