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 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.

A comparative study of oral, sublingual and vaginal route of misoprostol as cervical ripening agent before surgical method of termination of first-trimester pregnancy

“…The results were comparable with the study by Saxena et al and Tang et al 10,11 Tang et al, as compared the absorbtion kinetics and systemic bioavailability of misoprostol by oral, sublingual and vaginal route and vaginal route with addition of water. 12 They found that sublingual misoprostol achieved significantly higher peak serum concentrations (574.8±250.7pg/ml) than oral (287.7±144.3 pg/ml; p <0.001) or vaginal (125.2±53.8pg/ml) routes.…”

“…These results were however different from those obtained by Saxena et al 10,13 The observed side effects like abdominal pain, loose motions, vaginal bleeding, nausea and vomiting were quite different from the earlier studies by Tang et al where the incidence was high which may be because of the higher and the frequent dosing used in the first study. 9,14 Vaginal bleeding in our study was less in the vaginal group than the other two groups, which could be attributed to the sustained peak plasma concentration in this route.…”

Analgesia/Pain Management in First Trimester Surgical Abortion

“…Cervical preparation may decrease pain during abortion procedures as it decreases the force needed to dilate the cervix. 10 Preparation with misoprostol reduced pain from aspiration abortion compared with placebo in one study, 11 but not in another. 5 One study which found sublingual misoprostol to be more effective at causing cervical dilation than the vaginal or oral route also noted less abortion pain with this route.…”

“…5 One study which found sublingual misoprostol to be more effective at causing cervical dilation than the vaginal or oral route also noted less abortion pain with this route. 11 Misoprostol, however, causes more pain during the preparation period than placebo. Ibuprofen can be used during this preparation time to reduce preprocedure cramping caused by misoprostol, but this has only been found to have a benefit in multiparous women.…”

Comparison of sublingual, vaginal, and oral misoprostol in cervical ripening for first trimester abortion

“…However, the data are scanty in Indian patients. [8] Hence, the present study was carried out to compare the effectiveness of 400 μ g of misoprostol through three different routes (vaginal, S/L, oral) for cervical ripening in first trimester abortion prior to VA. This study also evaluates other parameters like side effects, operative ease, and patient acceptability of various routes of administration.…”