Sublingual vs. vaginal misoprostol for cervical preparation before surgical abortion in the first trimester

Abstract

Background: Suction evacuation is the most common surgical method of first-trimester pregnancy termination and cervical dilatation is the most critical step. Misoprostol is increasingly being used as a cervical priming agent before suction evacuation although the ideal dosage and route of administration is not yet agreed upon. Objective: The present study aimed to compare the efficacy, side effects and acceptability of the sublingual vs. vaginal route of administration of misoprostol. Methodology: 120 women seeking first-trimester termination of pregnancy between 6 to 12 weeks of gestation were randomized to receive 400mcg of misoprostol either sublingually or vaginally. Women in the two groups were comparatively evaluated for cervical dilatation before a surgical abortion, operative blood loss, time duration of surgery, adverse effects and overall satisfaction with the route of administration. Result: Successful dilatation of more than 8mm was achieved in 41(68.3%) women in the sublingual group and 23(38 %) in the vaginal group (p<0.01). The mean cervical dilatation of 8.25 mm for the sublingual group was significantly higher than the 7.4 mm cervical dilation achieved in the vaginal group at two hours. The mean blood loss was 14.5 ml in group I and 14.63 in group II (p 0.32). The mean duration of the procedure was 4.09 minutes in group I and 4.57 minutes in group II (p 0.06). Side effects like nausea, diarrhoea, bleeding per vaginum and pain abdomen were significantly more with the sublingual route. Patient acceptability was high for the sublingual route (88%) as compared to the vaginal route (43%) (p<0.0001). Conclusion: Sublingual misoprostol is a more effective cervical priming agent as compared to vaginal misoprostol for first-trimester pregnancy termination by suction evacuation. Though side effects are more, they are mild and manageable. It also has good patient acceptability and ease of administration.

Keywords

• cervical ripening
• misoprostol
• suction evacuation