Sublingual versus vaginal misoprostol (400 μg) for cervical priming in first-trimester abortion: a randomized trial

Esteve, Josep Lluis Carbonell; Marí, José María Navarro; Valero, F. Carrión; Llorente, Margardel; Salvador, I.; Varela, L; Leal, Pedro; Candel, A.; Tudela, Ana; Serrano, María José; Muñoz, E.

doi:10.1016/j.contraception.2006.03.031

Cited by 16 publications

(8 citation statements)

References 18 publications

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“…Three studies have shown that 400 mcg of sublingual misoprostol is more effective than 400 mcg of oral misoprostol given 3 h prior to procedure in terms of baseline cervical dilatation and the force required for cervical dilation greater than 7 mm [89,108,150]. Sublingual administration has been shown to be either equivalent to or better than vaginal administration when 400 mcg is given 1 to 4 h preprocedure [93,99,109,112,114,[150][151][152]; however, it is associated with significantly more nausea (12.4% vs. 2.5%), vomiting (10.1% vs. 3.8%) and diarrhea (26.4% vs. 7.6%) [93,99,114]. Nonetheless, sublingual administration is associated with high patient and staff acceptability [93,109,112,150].…”

Section: Comparisonsmentioning

confidence: 99%

“…Sublingual administration has been shown to be either equivalent to or better than vaginal administration when 400 mcg is given 1 to 4 h preprocedure [93,99,109,112,114,[150][151][152]; however, it is associated with significantly more nausea (12.4% vs. 2.5%), vomiting (10.1% vs. 3.8%) and diarrhea (26.4% vs. 7.6%) [93,99,114]. Nonetheless, sublingual administration is associated with high patient and staff acceptability [93,109,112,150]. One study showed that 200 mcg of sublingual misoprostol given 2 h preoperatively was equivalent to 400 mcg of vaginal misoprostol given 3 h preoperatively in terms of cervical dilation [153].…”

Section: Comparisonsmentioning

confidence: 99%

“…One study showed that 200 mcg of sublingual misoprostol given 2 h preoperatively was equivalent to 400 mcg of vaginal misoprostol given 3 h preoperatively in terms of cervical dilation [153]. A Cochrane meta-analysis comparing sublingual to vaginal misoprostol favored the sublingual route, which was associated with less need for further dilation (RR: 1.41, 95% CI: 1.15-1.73) [93,99,112,114,123]. However, the sublingual route was associated with a higher occurrence of nausea [123].…”

Section: Comparisonsmentioning

confidence: 99%

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Cervical dilation before first-trimester surgical abortion (< 14 weeks' gestation)

Allen

Goldberg

2016

Contraception

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First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction abortion is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester include increasing gestational age and provider inexperience. Cervical priming before first-trimester surgical abortion has been studied using osmotic dilators and pharmacologic agents, most commonly misoprostol. Extensive data demonstrate that a variety of agents are safe and effective at causing preoperative cervical softening and dilation; however, given the small absolute risk of complications, the benefit of routine use of misoprostol or osmotic dilators in first-trimester surgical abortion is unclear. Although cervical priming results in reduced abortion time and improved provider ease, it requires a delay of at least 1 to 3 h and may confer side effects. The Society of Family Planning does not recommend routine cervical priming for first-trimester suction abortion but recommends limiting consideration of cervical priming for women at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be challenging.

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Section: Comparisonsmentioning

confidence: 99%

Section: Comparisonsmentioning

confidence: 99%

Section: Comparisonsmentioning

confidence: 99%

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Cervical dilation before first-trimester surgical abortion (< 14 weeks' gestation)

Allen

Goldberg

2016

Contraception

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“…They concluded that the preoperative cervical width and time to Hegar 10 were comparable among the three groups. In addition, the sublingual route was effective when compared with the vaginal and the oral routes for pregnancy termination [23,24]. However, to our knowledge, there have been no published studies comparing sublingual to other routes (including rectal) in nonpregnant premenopausal women undergoing hysteroscopy.…”

Section: Discussionmentioning

confidence: 95%

Prostaglandins prior to hysteroscopy

Moiety¹,

Azzam²

2011

Gynecol Surg

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This prospective randomized controlled study was conducted to assess the role of misoprostol, given sublingually or rectally, on the outcome of hysteroscopic procedures. A total of 212 premenopausal patients undergoing hysteroscopic procedures were randomly allocated into three groups: group 1 (n=71), sublingual misoprostal given 2 h before the procedure; group 2 (n=71) rectal misoprostal 2 h before the procedure; group 3 (n=70), control group, no medications were given. Main outcome measures were ease of cervical dilatation, dilatation time to Hegar 6, complications as cervical laceration and postoperative cramps, bleeding and pyrexia. The cervical canal at the start was significantly wider misoprostol groups (P= 0.038). Cervical dilatation was significantly easier in the rectal misoprostol group over control (P=0.035). Misoprostol groups showed significant reduction in the mean time needed to dilate to Hegar 6 (P=0.021). Postoperative pain and cramps were significantly higher in misoprostol groups (P=0.002). Misoprostol before hysteroscopy demonstrates a benefit in the ease of cervical dilatation, cervical width at the start and time for dilatation with low risk of cervical tears. Rectal misoprostol appears advantageous than sublingual one. However, postoperative adverse effects are more common with misoprostol groups.

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“…Few studies have shown sublingual route is more effective when compared with vaginal and oral for pregnancy termination. 8,9 There are only few studies comparing sublingual, oral and vaginal misoprostol in non pregnant post menopausal women. 1,10,11 The present study was undertaken to evaluate the efficacy of 400mcg of misoprostol administered vaginally or sublingually for cervical ripening before transcervical gynaecological diagnostic procedures in both pre and post menopausal women.…”

mentioning

confidence: 99%

Clinical use of misoprostol for cervical ripening before transcervical procedures in non pregnant women: a randomized comparison of vaginal and sublingual administrations

2015

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Sublingual versus vaginal misoprostol (400 μg) for cervical priming in first-trimester abortion: a randomized trial

Cited by 16 publications

References 18 publications

Cervical dilation before first-trimester surgical abortion (< 14 weeks' gestation)

Cervical dilation before first-trimester surgical abortion (< 14 weeks' gestation)

Prostaglandins prior to hysteroscopy

Clinical use of misoprostol for cervical ripening before transcervical procedures in non pregnant women: a randomized comparison of vaginal and sublingual administrations

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