Norway: Oral versus vaginal misoprostol at home

The study compared the impact of 400 mug oral versus self-administered vaginal misoprostol at home on pre-operative cervical priming in both primigravid and multigravid women prior to first trimester surgical abortion.

Department of Gynaecology, Women and Children’s Division, Ulleval University Hospital, Oslo: The study’s objective was to compare the impact of 400 mug oral versus self-administered vaginal misoprostol at home on pre-operative cervical priming in both primigravid and multigravid women prior to first trimester surgical abortion. This was a randomised controlled trial set in a Norwegian University Teaching Hospital, using a sample of 338 women undergoing surgical abortion between 7 and 12 weeks of gestation.

The women were randomised either to 400 microg of oral misoprostol the evening before or 400 microg of self-administered vaginal misoprostol at home the same day as vacuum aspiration. The main outcome measures were pre-operative cervical dilation, complications and acceptability. The median cervical dilation was 6.2 mm for the women in the 400 mug oral misoprostol and 6.5 mm in the 400-microg vaginal misoprostol groups. The median pre-operative dilation was larger in multigravidae (6.4 and 6.7 mm for the oral and vaginal routes, respectively) than in primigravidae (5.8 and 6.0 mm, respectively). In primigravidae, 19% achieved a pre-operative dilation of 7 mm or more, with no significant difference between oral and vaginal dosage. In multigravidae, 52% achieved a pre-operative dilation of 7 mm or more with vaginal dosage, compared with 36% with oral dosage. The 400 microg oral dosage group had a higher risk of bleeding, compared with the group receiving 400 microg vaginal misoprostol. All women found self-administered vaginal misoprostol this administration route acceptable. Complications were minor and were distributed equally between the two dosage groups.

The authors concluded that the vaginal route will result in a satisfactory dilation in about half of multigravidae but is much less effective in primigravidae. The oral route does not lead to satisfactory dilation in either group and is associated with a higher occurrence of pre-operative bleeding. Self-administered vaginal misoprostol at home is highly acceptable.

Oral versus self-administered vaginal misoprostol at home before surgical termination of pregnancy: a randomised controlled trial. Oppegaard KS, Qvigstad E, Nesheim BI. BJOG. 2006 Jan;113(1):58-64.