Oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration in women in the sixth to twelfth week of gestation

Abstract

The effectiveness of oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration was compared in women in the 6th to 12th week of pregnancy. Sixty-four nulliparous women requesting termination of pregnancy between 6th to 12th weeks of gestation were randomized to receive either 400 μg misoprostol orally or 1 mg vaginal gemeprost at 12 hr or 3 hr prior to vacuum aspiration, respectively. The cervical dilatation at vacuum aspiration, the ease of the subsequent surgical procedure, and the incidence of complications and side effects were compared between these two methods of cervical priming. The median cervical dilatation at vacuum aspiration in the misoprostol group was significantly greater than that in the gemeprost group (8.0 mm versus 7.0 mm, p<0.02). Preoperative side effects were significantly less frequent in the misoprostol group (p<0.01). The ease of dilatation assessed subjectively by the operating surgeons was also improved significantly in the misoprostol group (p<0.01). However, the duration of operation and blood loss were similar in both groups. Since misoprostol is also much cheaper and more convenient to use, we conclude that oral misoprostol is better than vaginal gemeprost for cervical dilatation prior to vacuum aspiration in first trimester pregnancy. | Given the importance of adequate cervical dilatation to vacuum aspiration abortion, the effectiveness of oral misoprostol and vaginal gemeprost was compared. The 64 study subjects, all in the first 6-12 weeks of pregnancy, were randomly assigned either to take 400 mcg of misoprostol the night before pregnancy termination or were given 50 mg of vitamin B6 (placebo for misoprostol) to be taken the night before the procedure followed by vaginal insertion of 1 mg of gemeprost three hours preoperatively. Preoperative side-effects--nausea, vomiting, abdominal pain, and vaginal spotting--were significantly greater (p 0.01) in the gemeprost group; 28 out of 32 women in the misoprostol group compared to only 17 out of 32 in the gemeprost group experienced no side effects. The mean baseline cervical dilatation of 8.1 mm in the misoprostol group was significantly greater (p 0.01) than that in the gemeprost group (7.0 mm) and the ease of further dilatation was rated by surgeons as easier than normal for 87.5% of women in the former group compared to 59.4% in the latter group (p 0.01). The duration of the procedure and mean blood loss were similar in both groups. In addition to being more effective than gemeprost, misoprostol is less expensive and stable at room temperature. This is the first prospective, randomized study of oral as opposed to vaginal administration of misoprostol for cervical dilatation.