title: Comparison of sublingual, vaginal, and oral misoprostol in cervical ripening for first trimester abortion.
abstract: OBJECTIVE
  To compare the effectiveness and tolerability of misoprostol as a cervical ripening agent in first trimester abortion through three different routes of administration before surgical evacuation (SE).
  
  
  METHODS
  It was a hospital based prospective randomized open labeled parallel study. A total of 150 randomly selected married women were divided in three groups for sublingual (S/L), vaginal and oral 400 μg of misoprostol single dose administration. The drug was administered 3-4 h before SE in the S/L and vaginal groups and 12 h before the procedure in the oral group. Efficacy was assessed on the basis of time taken for ripening, dilatation achieved, duration of the procedure, intra-operative blood loss, and pain score. The tolerability was noted on the basis of side effects.
  
  
  RESULTS
  The mean time taken for cervical ripening was less in sublingual administration (3.7±1.2 hr) as compared to the vaginal and oral routes. The S/L group had significant cervical dilatation (P<0.001) and the duration of SE was less as compared to the vaginal and oral routes. However, the mean intraoperative blood loss was more in sublingual as compared to the vaginal and oral groups. The intra-operative pain score of the S/L group was significantly lower (1.9±1.1, P<0.05) as compared to the vaginal (2.6±1.7) or oral route (3.3±1.7). Loose motions and nausea/vomiting were more with the S/L and oral routes while blood loss was more in the vaginal route.
  
  
  CONCLUSIONS
  Administration of misoprostol by the sublingual route is better than the oral and vaginal routes for cervical ripening.
authors.affiliation: Department of Pharmacology, Government Medical College, Srinagar (Kashmir), Jammu & Kashmir, India.
authors.forename: Shagufta
authors.initials: S
authors.lastname: Parveen
authors.forename: Zaffar Abbas
authors.initials: ZA
authors.lastname: Khateeb
authors.forename: S M
authors.initials: SM
authors.lastname: Mufti
authors.forename: M A
authors.initials: MA
authors.lastname: Shah
authors.forename: Vishal R
authors.initials: VR
authors.lastname: Tandon
authors.forename: S
authors.initials: S
authors.lastname: Hakak
authors.forename: Z
authors.initials: Z
authors.lastname: Singh
authors.forename: Shagufta
authors.initials: S
authors.lastname: Yasmeen
authors.forename: Shakeel A
authors.initials: SA
authors.lastname: Mir
authors.forename: Rehana
authors.initials: R
authors.lastname: Tabasum
authors.forename: Nasreen
authors.initials: N
authors.lastname: Jan