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Different routes of misoprostol for cervical priming in first trimester surgical abortions: a randomized blind trial

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare effectiveness and patient satisfaction of different routes of misoprostol for short-term (same day) cervical priming in first trimester surgical abortions.

Methods

In a blind randomized trial, patients undergoing surgical abortion at a gestational age of 6 + 0–14 + 6 were administered oral, vaginal, or sub-lingual 400 mcg misoprostol, 1.5 to 4 h prior to procedure. Surgeons blinded to patient allocation evaluated cervical priming. The primary outcome was initial cervical dilatation. Secondary outcomes were cervical consistency, ease of dilation, patient discomfort, and side effects.

Results

From July 2015 through May 2016, 120 patients were randomized as follows: 40 to oral, 40 to vaginal, and 40 to sublingual misoprostol administration. No differences were noted in patient age, gestational age, curettage indication (termination/delayed miscarriage), past vaginal delivery, and administration to procedure interval. Initial cervical dilatation was similar between the groups, as were cervical consistency and ease of dilation. Patients noted the greatest discomfort and side effects with sublingual administration. The followings were found to be independently associated with cervical dilatation in a linear regression analysis: sublingual administration, gestational age, missed abortion, and previous vaginal delivery. Side effects and administration to procedure interval were found non-significant.

Conclusion

The same day cervical priming for first trimester surgical abortion is similarly achieved with all routes of misoprostol administration. In cases of termination of pregnancy with no prior vaginal delivery, sublingual administration may be considered, but entails a higher rate of side effects and patient discomfort.

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Author contributions

HGH: Protocol/project development, data collection and management, data analysis, manuscript writing and editing. RK: Protocol/project development, data collection and management, data analysis, manuscript writing and editing. OG: Data collection and management, data analysis, manuscript writing and editing. HF: Protocol/project development, data collection and management, data analysis, manuscript writing and editing. RK: Protocol/project development, data analysis, manuscript writing and editing. JB: Protocol/project development, data analysis, manuscript writing and editing. RS: Protocol/project development, data analysis, manuscript writing and editing.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel

    Hadas Ganer Herman, Ram Kerner, Ohad Gluck, Hagit Feit, Ran Keidar, Jacob Bar & Ron Sagiv

  2. The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel

    Hadas Ganer Herman, Ram Kerner, Ohad Gluck, Hagit Feit, Ran Keidar, Jacob Bar & Ron Sagiv

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  1. Hadas Ganer Herman
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  2. Ram Kerner
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Correspondence to Hadas Ganer Herman.

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The authors declare no source of funding for the research.

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All authors declare no potential conflict of interest, including and financial or personal relationship which could viewed as one.

Ethical standards

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ganer Herman, H., Kerner, R., Gluck, O. et al. Different routes of misoprostol for cervical priming in first trimester surgical abortions: a randomized blind trial. Arch Gynecol Obstet 295, 943–950 (2017). https://doi.org/10.1007/s00404-017-4329-5

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  • DOI: https://doi.org/10.1007/s00404-017-4329-5

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