Cervical Priming with Misoprostol Prior to First Trimester Instrumental Curettage

Objective: This randomized trial compares the efficacy and side effects of sublingual and vaginal misoprostol for cervical priming before first-trimester instrumental curettage for management of cases with missed abortion. Subjects and Methods: Two-hundred pregnant women between 6 and 13 weeks of gestation diagnosed as missed abortion were included in this study. The women were ran- domly allocated into two groups. Group 1 (n=100) received 400μg of sublingual misoprostol and group 2 (n=100) received 400μg of vaginal misoprostol 3h prior to surgical intervention, curettage was done under intravenous analgesia, baseline cervical dilatation, duration of the procedure, operative blood loss, side effects and complications were noted in both groups. Results: There was a significant difference between the sublingual and vaginal misoprostol groups with respect to mean cervical dilatation (8.6mm Vs. 6.8mm, p 0.05) However, the duration of the procedure (4.08min Vs. 4.16min) and blood loss were not significantly different between the two groups. The women in the sublingual group experienced significantly more shivering and preoperative vaginal bleeding (p 0.05). None of the women in the two groups had either uterine perforation or excessive hemorrhage. Conclusion: Cervical priming has advantage of it shorter operation time, reduced blood loss and provide easier mechan- ical dilatation, sublingual administration of misoprostol is as effective as vaginal administration for cervical priming prior to surgical first-trimester instrumental curettage. Also it has the advantage of ease of use and more acceptable for the patient.