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ORIGINAL RESEARCH |
From the Department of Obstetrics and Gynaecology, National University Hospital, Singapore and the Biostatistics Consultancy Unit, National University Hospital Medical Institute, Singapore.
Address reprint requests to: Kuldip Singh, MD Department of Obstetrics and Gynecology National University Hospital Lower Kent Ridge Road Singapore 119074 E-mail: obgkuldi{at}nus.edu.sg
Objective: To determine the optimal interval for evacuation after preabortion cervical priming with vaginal misoprostol.
Methods: One hundred eighty healthy nulliparas requesting legal termination of pregnancy between 6 and 11 weeks’ gestation were assigned randomly to receive 400, 600, or 800 µg of intravaginal misoprostol. Vacuum aspiration was done after 3 hours in the 400-µg group and after 2 hours in the 600- and 800-µg groups. The degree of cervical dilatation before operation was measured with a Hegar dilator. Preoperative and intraoperative blood loss and associated side effects were also assessed.
Results: Eleven (18.3%) and 15 (25.0%) women in the 600-and 800-µg groups, respectively, had cervical dilatation of at least 8 mm after an interval of 2 hours; 55 (91.7%) women who received 400 µg for a 3-hour interval had similar cervical dilatation. Using 400 µg as a baseline, the odds ratio (OR) was 0.02; 95% confidence interval (CI) was 0.01, 0.06 for 600 µg and OR 0.03; 95% CI 0.01, 0.09 for 800 µg for achieving successful preabortion cervical dilatation of at least 8 mm. The mean cervical dilatation of 6.7 mm and 6.8 mm for the higher doses was also significantly less than that of 8.1 for the 400-µg dose (P < .001). The mean preoperative and intraoperative blood loss was only statistically different when the 400- and 800-µg groups were compared (P = .03). There were also significantly more side effects, namely abdominal pain and fever above 38.0C, in the 600- and 800-µg groups (P < .001), compared with the 400-µg group. When the 600- and 800-µg groups were compared, there were still significantly more women complaining of abdominal pain (P < .001). None of the women in the study required analgesics for pain or antipyretics for fever.
Conclusion: The minimal evacuation interval should be at least 3 hours for successful preabortion cervical priming.
This article has been cited by other articles:
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  O. S. Tang, K. H. Mok, and P. C. Ho A randomized study comparing the use of sublingual to vaginal misoprostol for pre-operative cervical priming prior to surgical termination of pregnancy in the first trimester Hum. Reprod., May 1, 2004; 19(5): 1101 - 1104. [Abstract] [Full Text] [PDF]
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 E. Ekerhovd, N. Radulovic, and A. Norstrom Gemeprost Versus Misoprostol for Cervical Priming Before First-Trimester Abortion: A Randomized Controlled Trial Obstet. Gynecol., April 1, 2003; 101(4): 722 - 725. [Abstract] [Full Text] [PDF]
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K. Blanchard, S. Clark, B. Winikoff, G. Gaines, G. Kabani, and C. Shannon Misoprostol for Women's Health: A Review Obstet. Gynecol., February 1, 2002; 99(2): 316 - 332. [Abstract] [Full Text] [PDF]
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 A. B. Goldberg, M. B. Greenberg, and P. D. Darney Misoprostol and Pregnancy N. Engl. J. Med., January 4, 2001; 344(1): 38 - 47. [Full Text] [PDF]
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