Sublingual versus vaginal misoprostol for cervical priming in early missed abortion

Abstract EN

Cervical priming has been shown to result in a shorter operative time, less blood loss and easier mechanical dilation, and these may reduce the incidence of complications associated with surgical management of abortion including cervical injury, uterine perforation, hemorrhage and incomplete abortion.

Both vaginal and oral administrations of misoprostol were found to be effective.

However, oral administration avoids vaginal examination in a busy day-surgery admission clinic.

Aim of the work : was to compare the effect of sublingual versus vaginal administration of misoprostol for pre-operative cervical priming before surgical termination of pregnancy in first trimester missed abortion.

Patients : the study comprised 80 patients who were divided into two groups : Group I (40 patients) who received misoprostol by vaginal route while group II (40 patients) who received misoprostol by sublingual route.

Methods : each patient was given 400 / ig misoprostol (2 tablets cytotec®) 4 hours before vacuum aspiration either vaginally (group I) or sublingually (group II).

Results : the use of sublingual misoprostol was as effective in preoperative cervical ripening as vaginal misoprostol.

It was associated with easy cervical dilation in 77.5 % of patients (31 patients from 40 total), versus easy dilation in 82.5 % of patients (33 patients from 40 total) with vaginal misoprostol.

Sublingual misoprostol did not increase the side effects of misoprostol than vaginal route.

Conclusion : sublingual route is an effective and convenient alternative to vaginal administration of misoprostol for cervical ripening and dilation.

It can be conveniently self-administered at home thereby decreasing hospital stay and cost.

It also has a good patient acceptability rate.