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Fertility control: Oral versus self‐administered vaginal misoprostol at home before surgical termination of pregnancy: a randomised controlled trial
Author(s) -
Oppegaard Kevin Sunde,
Qvigstad Erik,
Nesheim BrittIngjerd
Publication year - 2006
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2005.00798.x
Subject(s) - misoprostol , medicine , obstetrics , vacuum aspiration , pregnancy , abortion , odds ratio , confidence interval , cervix , randomized controlled trial , gynecology , population , surgery , family planning , research methodology , genetics , environmental health , cancer , biology
Objective To compare the impact of 400 μg 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. Design Randomised controlled trial. Setting Norwegian University Teaching Hospital. Sample Three hundred and thirty‐eight women undergoing surgical abortion between 7 and 12 weeks of gestation. Methods The women were randomised to either 400 μg of oral misoprostol the evening before or 400‐μg of self‐administered vaginal misoprostol at home the same day as vacuum aspiration. Main outcome measures Pre‐operative cervical dilatation, complications and acceptability. Results The median cervical dilatation was 6.2 mm (range 0–11 mm) for the women in the 400 μg oral misoprostol and 6.5 mm (range 0–11 mm) in the 400‐μg vaginal misoprostol groups. The median pre‐operative dilatation 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 dilatation of ≥7 mm, with no significant difference between oral and vaginal dosage. In multigravidae, 52% achieved a pre‐operative dilatation of ≥7 mm with vaginal dosage, compared with 36% with oral dosage ( P = 0.03). There was no difference between non‐immigrant versus immigrant women in pre‐operative cervical dilatation. The 400‐μg oral dosage group had a higher risk of bleeding, compared with the group receiving 400‐μg vaginal misoprostol [odds ratio (OR) = 10.4; confidence interval (CI) 5.2–20.8]. There was no difference between non‐immigrant and immigrant women in acceptability of self‐administered vaginal misoprostol; almost all women found this administration route acceptable. Complications were minor and were distributed equally between the two dosage groups. Conclusions The vaginal route will result in a satisfactory dilatation in about half of multigravidae but is much less effective in primigravidae. The oral route does not lead to satisfactory dilatation in either group and is associated with a higher occurrence of pre‐operative bleeding. Self‐administered vaginal misoprostol at home is highly acceptable.