title: Sublingual versus vaginal misoprostol for cervical ripening PRIOR TO manual vacuum aspiration under local anaesthesia: a randomized study.
abstract: OBJECTIVE
  To compare the effectiveness of sublingual and vaginal misoprostol application for cervical ripening prior to manual vacuum aspiration (MVA) under local anaesthesia for voluntary termination of pregnancy between 7 and 10 weeks of gestation.
  
  
  METHODS
  Prospective randomized study in which 72 women were randomly assigned to administration of either 400 microg vaginal misoprostol 3 hours prior to or 200 microg sublingual misoprostol 2 hours prior to the surgical procedure. We took the preoperative cervical dilatation that was achieved as the main outcome measure. The duration of the procedure, intra-operative blood loss, pain perception before and during the operation, patients' satisfaction, side effects and duration of post-operative bleeding were secondary outcome measures.
  
  
  RESULTS
  A similar pre-operative cervical dilatation was achieved in the sublingual and the vaginal groups (6.9 +/- 1.6 mm and 6.6 +/- 1.1 mm, respectively; p = 0.3). The duration of the operation, intra-operative blood loss, and patients' satisfaction did not differ between the two groups. Pain scores were significantly higher in the sublingual group than in the vaginal group, both after administration of misoprostol (p = 0.02) and during the procedure (p = 0.02). Nausea and vaginal spotting were significantly more frequent (p = 0.01 and p = 0.003, respectively), but post-operative bleeding significantly shorter (p = 0.003) in the sublingual group.
  
  
  CONCLUSIONS
  Administration of 200 microg sublingual misoprostol 2 hours before suction curettage under local anaesthesia was as effective as 400 microg vaginal misoprostol 3 hours before that procedure with regard to achieving cervical dilatation. It resulted in higher pre-operative and intra-operative pain scores without changing patients' satisfaction.
authors.affiliation: Department of Obstetrics and Gynaecology, Kocaeli University, School of Medicine, Kocaeli, Turkey. eray68@hotmail.com
authors.forename: E
authors.initials: E
authors.lastname: Caliskan
authors.forename: T
authors.initials: T
authors.lastname: Filiz
authors.forename: G
authors.initials: G
authors.lastname: Yucesoy
authors.forename: E
authors.initials: E
authors.lastname: Coskun
authors.forename: B
authors.initials: B
authors.lastname: Vural
authors.forename: A
authors.initials: A
authors.lastname: Corakci
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000028:Abortion, Induced / Q000379:methods* / Q000523:psychology; D000282:Administration, Intravaginal; D000286:Administration, Sublingual; D000328:Adult; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D020070:Cervical Ripening / Q000187:drug effects*; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D009325:Nausea / Q000139:chemically induced; D010147:Pain Measurement; D017060:Patient Satisfaction; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D014619:Vacuum Curettage; D014621:Vagina / Q000187:drug effects
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol