The Effectiveness of Sublingual or Oral Administration of Misoprostol for Cervical Ripening before Manual Vacuum Aspiration in First Trimester Termination of Pregnancy: Randomized Controlled Trial

Awassada Punyashthira MD*, Densak Pongrojpaw MD*, Komsun Suwannarurk MD*, Kornkarn Bhamarapravatana PhD**

Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Department of Preclinical Science, Faculty of Medicine, Thammasat University, Pathumthani, Thailand

Objective : To compare the effectiveness of misoprostol sublingual and oral routes before manual vacuum aspiration (MVA) in first trimester termination of pregnancy. Material and Method: A double-blinded randomized controlled trial was conducted in first trimester termination of pregnancy cases. Eighty cases were recruited and divided into sublingual and oral groups. Both groups were randomized to receive 400 μg misoprostol two hours prior to MVA. Main outcomes were cervical dilatation, operative time, complications, side effects, pain scores, and patient satisfactions.
Results : Sublingual group had significantly more cervical dilatation and shorter operative time than oral group (7.31.5 vs. 5.91.4 mm, p<0.001 and 5.23.3 vs. 7.34.6 min, p = 0.02, respectively). However, there were similar side effects, pain scores, and patient satisfactions in two groups. The present study had no uterine perforation, cervical tear, hemorrhage, or re-evacuation.
Conclusion : Sublingual misoprostol route was more effective for cervical priming prior to MVA in first trimester therapeutic abortion than oral route.

Keywords : First trimester abortion, Cervical ripening, Manual vacuum aspiration, Misoprostol, Oral, Sublingual

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