title: Different routes of misoprostol for cervical priming in first trimester surgical abortions: a randomized blind trial.
abstract: OBJECTIVE
  To compare effectiveness and patient satisfaction of different routes of misoprostol for short-term (same day) cervical priming in first trimester surgical abortions.
  
  
  METHODS
  In a blind randomized trial, patients undergoing surgical abortion at a gestational age of 6 + 0-14 + 6 were administered oral, vaginal, or sub-lingual 400 mcg misoprostol, 1.5 to 4 h prior to procedure. Surgeons blinded to patient allocation evaluated cervical priming. The primary outcome was initial cervical dilatation. Secondary outcomes were cervical consistency, ease of dilation, patient discomfort, and side effects.
  
  
  RESULTS
  From July 2015 through May 2016, 120 patients were randomized as follows: 40 to oral, 40 to vaginal, and 40 to sublingual misoprostol administration. No differences were noted in patient age, gestational age, curettage indication (termination/delayed miscarriage), past vaginal delivery, and administration to procedure interval. Initial cervical dilatation was similar between the groups, as were cervical consistency and ease of dilation. Patients noted the greatest discomfort and side effects with sublingual administration. The followings were found to be independently associated with cervical dilatation in a linear regression analysis: sublingual administration, gestational age, missed abortion, and previous vaginal delivery. Side effects and administration to procedure interval were found non-significant.
  
  
  CONCLUSIONS
  The same day cervical priming for first trimester surgical abortion is similarly achieved with all routes of misoprostol administration. In cases of termination of pregnancy with no prior vaginal delivery, sublingual administration may be considered, but entails a higher rate of side effects and patient discomfort.
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel. hadassganer@yahoo.com.|The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel. hadassganer@yahoo.com.
authors.forename: Hadas
authors.initials: H
authors.lastname: Ganer Herman
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel.|The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel.
authors.forename: Ram
authors.initials: R
authors.lastname: Kerner
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel.|The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel.
authors.forename: Ohad
authors.initials: O
authors.lastname: Gluck
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel.|The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel.
authors.forename: Hagit
authors.initials: H
authors.lastname: Feit
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel.|The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Keidar
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel.|The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bar
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel.|The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Sagiv
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000284:Administration, Oral; D000286:Administration, Sublingual; D000328:Adult; D005260:Female; D006801:Humans; D007747:Labor Stage, First / Q000187:drug effects*; D016014:Linear Models; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D017060:Patient Satisfaction; D011247:Pregnancy; D011261:Pregnancy Trimester, First
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Cervical ripening; Misoprostol; Missed abortion; Surgical abortion; Termination of pregnancy