title: A comparative study using two dose regimens (200 microg or 400 microg) of vaginal misoprostol for pre-operative cervical dilatation in first trimester nulliparae.
abstract: OBJECTIVE
  To determine the optimal dosage and dosing interval for the use of misoprostol administered vaginally for pre-operative cervical dilatation.
  
  
  METHODS
  Prospective double-blind randomised study.
  
  
  METHODS
  Fertility Control Centre, National University Hospital, Singapore.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: Y F
authors.initials: YF
authors.lastname: Fong
authors.forename: K
authors.initials: K
authors.lastname: Singh
authors.forename: R N
authors.initials: RN
authors.lastname: Prasad
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000028:Abortion, Induced / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010298:Parity; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000209:etiology; D014620:Vacuum Extraction, Obstetrical / Q000379:methods
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol