Oral versus vaginal misoprostol administered one hour before surgical termination of pregnancy: a randomised controlled trial

Objective  To assess the efficacy of oral and vaginal misoprostol as cervical priming agents administered 1 hour before first trimester surgical termination of pregnancy. Design  A randomised controlled trial. Setting  Chelsea and Westminster Hospital, London. Population  Pregnant women of 10 weeks or less gestation attending the termination of pregnancy clinic. Methods  Ninety eligible women were recruited to the study during September 2001 and September 2002. Women were randomised to one of the three groups: misoprostol administered orally (400 μg), misoprostol administered vaginally (800 μg) and standard care (no cervical priming agent) administered prior to surgical termination of pregnancy. Under general anaesthesia, and prior to the operation, a cervical tonometer was used to determine the main outcome measures. Main outcome measures  Baseline cervical dilatation and the cumulative force required to dilate the cervix from 3 to 9 mm. Results  There was no significant difference in the mean baseline cervical dilation (P= 0.16) or the cumulative force required to dilate the cervix (P= 0.12) between the three randomised groups. Conclusion  No cervical priming effects were detectable with oral or vaginal misoprostol administered 1 hour before first trimester surgical termination of pregnancy.