title: A randomised comparison between sublingual, oral and vaginal route of misoprostol for pre-abortion cervical ripening in first-trimester pregnancy termination under local anaesthesia.
abstract: OBJECTIVE
  To compare efficacy of sublingual (S/L), oral and vaginal routes of misoprostol administration for cervical priming before suction evacuation (SE) under local anaesthesia.
  
  
  METHODS
  In a prospective randomised clinical trial, 200 women in the first trimester of pregnancy were randomised into four groups of 50 each. Patients in control group did not receive any medication before SE while other treatment groups received 400 microg of misoprostol three hours prior to SE either by sublingual/oral or by vaginal route. Main outcome measure was basal cervical dilatation while the secondary outcome measures were operative blood loss, time duration of surgery, patient satisfaction, pain perception and adverse effects.
  
  
  RESULTS
  Sublingual group had a higher dilatation (9.9 +/- 2.1 mm; P < 0.001) and lower time duration of surgery (3.6 +/- 1.0 min; P < 0.01) as compared to oral (8.2 +/- 2.6 mm, 4.9 +/- 1.7 min) or vaginal routes (7.6 +/- 2.6 mm, 5.2 +/- 1.8 min). Mean pain score of the sublingual group was significantly lower (2.4 + 1.3; P < 0.001) as compared to oral (3.4 +/- 1.3) or vaginal routes (3.6 +/- 1.2). Patient acceptability was higher for sublingual (53 of 150) and oral routes (62 of 150) as compared to vaginal (35 of 150) route.
  
  
  CONCLUSIONS
  Sublingual route was significantly more effective than oral or vaginal administration of misoprostol for cervical dilatation. To the best of our knowledge, this is the first study to simultaneously compare the efficacy of sublingual, oral and vaginal routes of misoprostol for cervical priming before SE.
authors.affiliation: Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. pikeesaxena@hotmail.com
authors.forename: Pikee
authors.initials: P
authors.lastname: Saxena
authors.forename: Nivedita
authors.initials: N
authors.lastname: Sarda
authors.forename: Sudha
authors.initials: S
authors.lastname: Salhan
authors.forename: Deoki
authors.initials: D
authors.lastname: Nandan
mesh_terms: D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000284:Administration, Oral; D000286:Administration, Sublingual; D000328:Adult; D000772:Anesthesia, Local; D020070:Cervical Ripening / Q000187:drug effects*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D016595:Misoprostol / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies
chemical_list: D010120:Oxytocics; D016595:Misoprostol