Randomised controlled study comparing oral and vaginal misoprostol for cervical priming prior to surgical termination of pregnancy

Abstract

Objective: To compare the effectiveness of oral misoprostol with vaginal misoprostol as a cervical priming agent prior to first trimester vacuum aspiration.

Design: Randomised study.

Setting: Scottish teaching hospital.

Population: Primigravid women at gestations up to 91 days requesting surgical abortion under the 1967 Abortion Act.

Methods: Sixty-four women were randomised to receive misoprostol 400 microg orally at home or vaginally in hospital 2-4 hours pre-operatively for cervical priming.

Main outcome measures: The main outcome measures were cumulative force required to dilate the cervix to 9 mm, baseline cervical dilatation, intra-operative blood loss and patient and staff acceptability.

Results: There was no significant difference in baseline cervical dilatation, peak force required to dilate the cervix at 8 and 9 mm and cumulative force required between the two groups. Operating time and intra-operative blood loss were not significantly different between the two groups. The priming to abortion interval was significantly longer with oral misoprostol when compared with the vaginal group (P < 0.0001). Women receiving oral misoprostol were significantly more likely to experience nausea (OR: 3.9, 95% CI: 1.3 to 11.2), while women receiving vaginal misoprostol were more likely to complain of tiredness (OR: 0.2, 95% CI: 0.1 to 0.7) with no significant differences in other side effects between the two groups. There was no significant difference in patient acceptability in relation to the priming agent between the two groups (P = 0.96). However, majority of the nursing staff (83%) admitting women preferred the oral route of administration.

Conclusion: Cervical priming with oral misoprostol at home is effective with high patient and staff acceptability.