Oral versus self-administered vaginal misoprostol at home before surgical termination of pregnancy: a randomised controlled trial.
OBJECTIVE
To compare the impact of 400 mug oral versus self-administered vaginal misoprostol at home on pre-operative cervical priming in both primigravid and multigravid women prior to first trimester surgical abortion.


METHODS
Randomised controlled trial.


METHODS
Norwegian University Teaching Hospital.


METHODS
Three hundred and thirty-eight women undergoing surgical abortion between 7 and 12 weeks of gestation.


METHODS
The women were randomised to either 400 microg of oral misoprostol the evening before or 400-microg of self-administered vaginal misoprostol at home the same day as vacuum aspiration. Main outcome measures Pre-operative cervical dilatation, complications and acceptability.


RESULTS
The median cervical dilatation was 6.2 mm (range 0-11 mm) for the women in the 400 mug oral misoprostol and 6.5 mm (range 0-11 mm) in the 400-microg vaginal misoprostol groups. The median pre-operative dilatation was larger in multigravidae (6.4 and 6.7 mm for the oral and vaginal routes, respectively) than in primigravidae (5.8 and 6.0 mm, respectively). In primigravidae, 19% achieved a pre-operative dilatation of > or = 7 mm, with no significant difference between oral and vaginal dosage. In multigravidae, 52% achieved a pre-operative dilatation of > or = 7 mm with vaginal dosage, compared with 36% with oral dosage (P = 0.03). There was no difference between non-immigrant versus immigrant women in pre-operative cervical dilatation. The 400-microg oral dosage group had a higher risk of bleeding, compared with the group receiving 400-microg vaginal misoprostol [odds ratio (OR) = 10.4; confidence interval (CI) 5.2-20.8]. There was no difference between non-immigrant and immigrant women in acceptability of self-administered vaginal misoprostol; almost all women found this administration route acceptable. Complications were minor and were distributed equally between the two dosage groups.


CONCLUSIONS
The vaginal route will result in a satisfactory dilatation in about half of multigravidae but is much less effective in primigravidae. The oral route does not lead to satisfactory dilatation in either group and is associated with a higher occurrence of pre-operative bleeding. Self-administered vaginal misoprostol at home is highly acceptable.
Oppegaard
Kevin Sunde
KS
Department of Gynaecology, Women and Children's Division, Ullevål University Hospital, Kirkeveien 166, N-0407 Oslo, Norway.
Qvigstad
Erik
E
Nesheim
Britt-Ingjerd
BI
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D005260:Female; D020073:Gravidity; D006699:Home Care Services; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage*; D017060:Patient Satisfaction; D011247:Pregnancy; D012646:Self Administration / Q000379:methods
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol