November 27th, 2015

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Comparison of Different Preoperative Sublingual Misoprostol Regimens for Surgical Termination of First Trimester Pregnancies: A Prospective Randomized Trial
Authors:  C. M. Ercan, M.D., H. Coksuer, M.D., K. E. Karasahin, M.D., I. Alanbay, M.D., U. Aydogan, M.D., A. Parlak, M.D., and I. Baser, M.D.
  OBJECTIVE: To determine the appropriate dose of sublingual misoprostol administration before dilation and curettage (D&C) of the uterus in first trimester pregnancies.

STUDY DESIGN: Ninety nulliparous women who underwent surgical termination of first trimester pregnancy were analyzed prospectively. The first group (n=30) received a single 200-g dose, and the second (n=30) and third (n=30) groups were administered 2200 g (400 g) and 3200 g (600 g) doses of misoprostol sublingually, respectively, with 1-hour intervals. The main outcomes evaluated were the degree of difficulty of cervical dilation, adverse effects of misoprostol according to dose administered, and participant satisfaction rate with the procedure.

RESULTS: The improvement in cervical dilation and the ease of the D&C procedure were more significant in the 600-g misoprostol arm (p=0.008). Because the prevalence and severity of the side effects of misoprostol were increased in a dose-dependent manner, the 400-g arm was found to be the most efficient dose of the study with its high satisfaction rate (p<0.001).

CONCLUSION: Premedication with misoprostol makes the D&C procedure easier by leading to cervical ripening. By sublingual route 400 g of misoprostol regimen seems to be appropriate for planned first trimester surgical pregnancy termination under local anesthesia. Misoprostol should be administered only to select and hospitalized patients.
Keywords:  D&C; misoprostol; pregnancy, first trimester; sublingual administration; surgical termination
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