Effectiveness of Vaginal Misoprostol Application for Cervical Priming in First-Trimester Pregnancy Termination: A Randomized Clinical Trial
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Abstract
Objective To evaluate the effectiveness of vaginal Misoprostol application for cervical priming in first-trimester pregnancy termination, and its side effects.
Design Randomized clinical trial.
Setting Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol
University.
Subjects A total of 40 pregnant women of less than 13 weeks’ gestation who were indicated for termination of pregnancy and agreed to participate.
Methods All pregnant women were randomized into two groups. Women in the treatment group received vaginal application of Misoprostol 400 pg, while those in control group received nothing before uterine curettage. Cervical dilatation was assessed at baseline and 4 hours later. Termination of pregnancy by either dilatation and curettage or sharp curettage alone was then performed according to the condition of the cervix.
Main outcome measures Cervical os diameter at baseline and 4 hours apart.
Results After 4 hours of vaginal Misoprostol administration, the mean cervical os diameter in
the treatment group was significantly greater than that of control group (8.0 + 1.7 mm and 4.4 ± 2.0 mm respectively, p < 0.001). Proportion of women who achieved cervical os dilatation of at least 8 mm was also significantly higher in treatment group than control group (85% and 5% respectively, p < 0.001). Operative time was significantly shorter in the treatment group while blood loss was comparable between the 2 groups. Only 2 women in the treatment group experienced minor side effects.
Conclusion A single-dose vaginal suppository of Misoprostol 400 pg without any solvent added for 4 hours was highly effective for cervical priming before first-trimester pregnancy termination, without significant side effects or any serious complications. The regimen appeared to be useful in decreasing the need for mechanical cervical dilatation and may also prevent possible complications from such procedure.