Vaginal vs. sublingual misoprostol with mifepristone for cervical priming in second-trimester abortion by dilation and evacuation: a randomized clinical trial.
OBJECTIVE
The study was conducted to assess the effectiveness of mifepristone 200 mg 48 h before administering misoprostol 600 mug, sublingual vs. vaginal route, prior to dilation and evacuation (D&E) in 12- to 20-week pregnancies.


METHODS
Randomized clinical trial.


METHODS
Clínica Mediterrania Médica, Valencia, Spain.


METHODS
Women with 12- to 20-week pregnancies wanting a voluntary abortion between July 9, 2004, and February 9, 2006.


METHODS
Nine hundred women were randomized to be included in one of the following four groups: (I) mifepristone 200 mg plus sublingual misoprostol 600 microg before D&E, (II) mifepristone 200 mg plus vaginal misoprostol 600 microg before D&E, (III) sublingual misoprostol 600 microg before D&E and (IV) vaginal misoprostol 600 microg before D&E.


METHODS
The degree of cervical dilation achieved before D&E, surgical time necessary to terminate the pregnancy and side effects of misoprostol.


RESULTS
The average cervical dilation in the mifepristone groups was 12.5+/-2.8 mm (SD) [95% confidence interval (CI), 12.3-12.8] vs. 8.5+/-3.2 mm (SD) (95% CI, 8.2-8.8) in those receiving only misoprostol. Surgical time in the mifepristone sublingual misoprostol group was 11.9+/-4.3 min (SD) vs. 13.0+/-5.3 min (SD) in the sublingual misoprostol group without mifepristone (p=.007); in the mifepristone vaginal misoprostol group, the average surgical time was 12.3+/-5.0 min (SD) vs. 13.0+/-6.2 (SD) in the vaginal misoprostol group without mifepristone (p=.031).


CONCLUSIONS
Administering mifepristone before D&E with misoprostol in second-trimester abortions makes surgery easier and shorter and, to a certain extent, lessens the risk of cervical injuries, especially in D&E in advanced gestational periods.
Carbonell
Josep Lluis
JL
Gynecology-Obstetric Service, Mediterrania Medica Clinic, 46017 Valencia, Spain. schja@infoemd.sld.cu
Gallego
Francisca García
FG
Llorente
Margardell Perez
MP
Bermudez
Santiago Barambio
SB
Sala
Eugenia Sánchez
ES
González
Lidia Varela
LV
Texido
Carlos Sánchez
CS
D000019:Abortifacient Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D000028:Abortion, Induced; D000282:Administration, Intravaginal; D000286:Administration, Sublingual; D004107:Dilatation and Curettage / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015735:Mifepristone / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D016896:Treatment Outcome
D000019:Abortifacient Agents; D016595:Misoprostol; D015735:Mifepristone