A comparative study of oral, sublingual and vaginal route of misoprostol as cervical ripening agent before surgical method of termination of first-trimester pregnancy

Abstract

INTRODUCTIONLegally induced abortions, called as medical termination of pregnancy, form a major bulk in every day practice of gynaecology. Medication abortion (also referred to as medical abortion) is the termination of pregnancy with use of medications alone rather than surgery. Mifepristone, 200mg in combination with misoprostol, 800mcg is more effective up to 49 days of gestation, rather than in late first trimester of pregnancy.1 It is however not always the method of choice because of the long-time consumed to complete the abortion, inconvenience due to prolonged bleeding per vagina (P/V) and the risk of excessive bleeding P/V makes it unsuitable for its use in areas where round the clock emergency services are not available. Therefore, the surgical method like vacuum aspiration, dilatation and evacuation still remains the procedure of choice for termination of pregnancy. Cervical ripening or softening is the determining step for success of surgical method of termination. Insufficiently dilated cervix may cause difficulty in evacuating the uterus, excessive hemorrhage ABSTRACT Background: Cervical ripening is a critical step for surgical method of termination of first trimester of pregnancy. Misoprostol, PGE1 analogue have promising role as cervical ripening agent. The present study aimed to compare the efficacy and side effects of oral, sublingual and vaginal misoprostol at dosage of 400mcg for cervical priming before surgical method of termination in first-trimester pregnancy. Methods: It was a prospective hospital based randamosied study. Total 150 patients at 6-12 weeks gestation requesting for medical termination of pregnancy were divided equally in to 3 groups. Every group was advised to have single dose of 400 mcg misoprostol either oral, sublingual or vaginal route respectively 4 hour before suction and evacuation. Results: The sublingual group had highly significant cervical dilatation (P<0.001) and the duration of suction and evacuation was less as compared to the vaginal and oral routes (p<0.000). However, the mean intraoperative blood loss was more in sublingual as compared to the vaginal and oral groups. Loose motions and nausea/vomiting were more with oral routes while blood loss was more in the vaginal route. Conclusions: Thus, it can be concluded from present study that sublingual route of misoprostol is more preferable than oral or vaginal route as pro-abortion cervical ripening agent.