Canada: Assessment of pain after abortion relating to the use of misoprostol for cervical dilatation

The study’s objective was to compare the use of misoprostol to that of laminaria tents for dilatation of the cervix before a surgical elective abortion (EAB) during the first trimester, with regard to the pain caused (1) during insertion, for both methods, (2) immediately before the EAB, and (3) one hour after the procedure. From Journal of Obstetrics and Gynaecology Canada.

One hundred two women were recruited at Clinique de planification des naissances du Centre hospitalier universitaire de Québec, CHUL pavilion, between March 1, 2006 and March 1, 2007, for a tracking study. Fifty-three women were given 400 microg of misoprostol intravaginally, three to four hours before the EAB, and a laminaria tent was inserted in 49 women, 16 to 24 hours before the EAB. A visual analog scale was used to determine the pain score.

The results found that one hour after EAB, severe pain was reported in 6% of the participants who were given misoprostol. The pain score post-EAB was 3.8 times higher in women who were given misoprostol than in those who had a laminaria tent inserted (P = 0.004). The pain score during insertion of the dilatation method was 33 times higher with the laminaria tent than with misoprostol (P < 0. 001), and 30% of women who had a laminaria tent inserted felt severe pain.

The authors concluded that while misoprostol may increase pain after EAB in a small percentage of women, it remains an efficient, easy to use, low-cost method for dilating the cervix before an EAB. It is one of the options that may be offered to women when a pre-EAB dilatation of the cervix is required, after discussing its benefits and disadvantages with them.

Department of Obstetrics and Gynecology, Centre hospitalier universitaire de Québec, Quebec QC.

Assessment of pain after elective abortion relating to the use of misoprostol for dilatation of the cervix. Gagné A, Guilbert E, Ouellet J, Roy V, Tremblay JG. Journal of Obstetrics and Gynaecology Canada. 2010 Mar;32(3):244-53.