A comparative study using two dose regimens (200 μg or 400 μg) of vaginal misoprostol for pre‐operative cervical dilatation in first trimester nulliparae
- 1 April 1998
- journal article
- clinical trial
- Published by Wiley in BJOG: An International Journal of Obstetrics and Gynaecology
- Vol. 105 (4), 413-417
- https://doi.org/10.1111/j.1471-0528.1998.tb10126.x
Abstract
To determine the optimal dosage and dosing interval for the use of misoprostol administered vaginally for pre-operative cervical dilatation. Prospective double-blind randomised study. Fertility Control Centre, National University Hospital, Singapore. Women were randomly allocated to either the 200 microg or the 400 microg misoprostol group. Vacuum aspiration was performed at either three or four hours after the insertion of misoprostol tablets. Using Hegar's dilatator, degree of cervical dilatation before operation was measured. Other parameters assessed included the amount of additional dilatation required (if it was < Hegar 8), pre-operative and intra-operative blood loss, and associated side effects. For the 200 microg misoprostol group, only seven (23.3%) achieved a dilatation of > or = 8 mm compared with 29 women (96.7%) in the 400 microg misoprostol group. The odds ratio was 95.3 (95% CI 10.9-830.9) for 400 microg misoprostol for successful pre-operative cervical dilatation of > or = 8 mm. The mean cervical dilatation for 400 microg and 200 microg misoprostol was 8.2 mm and 6.4 mm, respectively (P < 0.001). The use of 400 microg misoprostol with an evacuation interval of three hours appears to be the optimal dosage and evacuation time interval. Increasing the time interval beyond three hours did not confer any additional advantage on the rate of successful cervical dilatation but was instead associated with an increase in side effects such as vaginal bleeding, lower abdominal pain and the appearance of products of conception at the cervical os. However, besides vaginal bleeding, no significant differences in the frequency of these side effects were demonstrated. This first report on the comparison of differing dosages and time intervals to determine the optimal dosage treatment schedule shows that the vaginal application of 400 microg misoprostol for at least three hours is optimal for pre-operative cervical dilatation before vacuum aspiration in first trimester nulliparae.Keywords
This publication has 13 references indexed in Scilit:
- Oral misoprostol versus mifepristone for cervical dilatation before vacuum aspiration in first trimester nulliparous pregnancy: a double blind prospective randomised studyBJOG: An International Journal of Obstetrics and Gynaecology, 1996
- A randomised comparison of oral and vaginal misoprostol for cervical priming before suction termination of pregnancyBJOG: An International Journal of Obstetrics and Gynaecology, 1996
- Oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration in women in the sixth to twelfth week of gestationContraception, 1995
- Cervical priming with prostaglandin E1 analogues, misoprostol and gemeprostThe Lancet, 1994
- Misoprostol, mifepristone, and abortionThe Lancet, 1992
- Uterine contractility and induction of abortion in early pregnancy by misoprostol and mifepristoneThe Lancet, 1991
- The use of mifepristone (RU 486) for cervical preparation in first trimester pregnancy termination by vacuum aspirationBJOG: An International Journal of Obstetrics and Gynaecology, 1990
- lntracervical TentsObstetrical & Gynecological Survey, 1989
- Prevention of uterine perforation during curettage abortionPublished by American Medical Association (AMA) ,1984
- MEASURES TO PREVENT CERVICAL INJURY DURING SUCTION CURETTAGE ABORTIONThe Lancet, 1983