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 µg 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. Conclusion:  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.

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IntrOductIOnIn developing countries, 17% women of reproductive age have unmet needs for family planning [1,2] and 20.6% of pregnancies are reported to occur during previous lactation [3]. The incidence of unintended pregnancy during the first year postpartum was found to be 12.8 per 100 women years and 86% had resulted from non use of contraception [3]. Delaying contraception until first visit to hospital or sixth week postpartum increase the risk of unintended pregnancy. Progesterone only contraceptives in form of injectable depot medroxy progesterone acetate (DMPA) is a highly effective method for contraception especially in postpartum period.Progesterone contraception after birth is frequently recommended but the timing of initiation of depot medroxy progesterone acetate (DMPA) after delivery is controversial. Product labelling recommends initiating depot medroxy progesterone acetate (DMPA) four to six weeks postpartum regardless of breastfeeding status [4]. WHO recommends depot medroxy progesterone acetate (DMPA) in breastfeeding women should be initiated at 6 weeks [5]. ACOG recognizes the need for clinical judgement and weighing the need for contraception against theoretical risks and endorses the earlier initiation of DMPA postpartum in certain clinical situations, such as high risk of being lost to follow-up postpartum [6]. Theoretical concerns of infant safety and premature inhibition of lactation remain with early postpartum administration of depot medroxy progesterone acetate (DMPA). It is thought that newborn's system is immature to metabolize steroid hormones and therefore early initiation could affect the new born adversely [5]. However studies obstetrics and gynaecology Section indicate that infants are neither able to metabolize nor absorb progestin effectively until three months of age and the amount of hormone transferred is 0.05% of the maternal dose [7]. Another issue of interference with milk quality and production is also addressed and it has been shown that Progesterone only contraception may not impair lactation [8][9][10].Thus there exist a gap between existent evidence regarding early initiation of postpartum medroxy progesterone use and its impact on infant health and breast feeding. In present study we aimed to evaluate impact of short term use of inj DMPA in early postpartum period on infant health and breast feeding performance. MAterIAls And MethOdsA prospective case control study was conducted in department of Obstetrics and Gynaecology in a tertiary care teaching hospital. A total of 250 women who wanted some form of reversible contraception immediately after delivery were recruited in the study. All the women who were included were apparently healthy, 20-35-year-old women and had delivered a baby of gestational age ≥ 36 weeks and birth weight ≥ 2.5 kg. The recruited subjects had no medical or surgical illness including local abscess/ inverted nipple or breast pathology. Baby was with mother since birth and women were ready to follow-up. Grand multiparous women or those who had ...