Vaginal dinoprostone versus oral misoprostol for predilatation of the cervix in first trimester surgical abortion
- PMID: 9521394
- DOI: 10.1111/j.1479-828x.1998.tb02961.x
Vaginal dinoprostone versus oral misoprostol for predilatation of the cervix in first trimester surgical abortion
Abstract
Prostaglandins are effective in predilatation of the cervix prior to first trimester surgical termination of pregnancy under local analgesia. Arandomized open comparative trial was devised to compare the effectiveness and acceptability of vaginal dinoprostone with oral misoprostol. Two groups were randomized to control for age, parity and ethnicity. The operation was easier and less painful in older, parous, and Polynesian women. Both methods were effective with respect to ease of dilatation. Both were acceptable and equal with respect to the level of pain experienced by the woman during the operation. Vaginal dinoprostone is more gradual in its action, but it is more expensive, has to be refrigerated and self-insertion may sometimes cause problems. Oral misoprostol is considerably cheaper and does not require refrigeration, but it was associated with more preoperative nausea, cramping and occasional heavy bleeding.
PIP: The effectiveness and side effects of vaginal dinoprostone and oral misoprostol for cervical predilatation in first-trimester surgical abortion were compared in a study conducted at a New Zealand abortion clinic. Over a 3-month period in 1995, abortion patients at Parkview Clinic (Wellington South, New Zealand) were randomized to produce two groups matched for age, parity, and ethnicity. The first group (n = 153) received a vaginal suppository containing 3 mg of dinoprostone, which they inserted themselves at least 12 hours in advance of surgery; women in the second group (n = 160) were given 400 mcg of oral misoprostol at the clinic at least 1 hour in advance of abortion. Misoprostol was associated with more cramping, preoperative vaginal bleeding, and nausea than dinoprostone. Pain ratings did not differ significantly between groups. Overall, dilatation was slightly easier with misoprostol than with dinoprostone. The operation was also easier and less painful in older, parous, and Polynesian women. In the 54 cases where dilatation was rated as difficult, 48 women (88.9%) were nulliparous. Misoprostol is less expensive than dinoprostone and does not require refrigeration. As a result of these findings, Parkview Clinic has decided to use misoprostol for cervical dilatation.
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