Is there an optimum time interval from vaginal misoprostol
administration to surgical abortion?
A K Banerjee, T Singhal and J O Emembolu
Leicester Royal Infirmary, O & G, Leicester, United
Background and objective Studies have shown that cervical
priming reduces the risks of intra-operative trauma during surgical abortion.
The RCOG recommends that misoprostol should be administered vaginally 3 hours
prior to surgical abortion. This is not always feasible on a morning theatre
list. This study is to determine the effectiveness of misoprostol administered
vaginally on admission in establishing adequate cervical priming for surgical
Methods This is a prospective study conducted in a
teaching hospital between 1st April 2003 and 31st March 2004. Women, requesting
first trimester surgical abortion, were consented and enrolled in the study.
Each patient received 600mcg of misoprostol administered vaginally on admission.
The time of administration, time of surgical procedure, point at which initial
resistance to graduated Hegar dilators, and difficulties during dilatation was
documented carefully. Cervical priming was considered satisfactory if resistance
was not encountered at 8 mm dilatation, the standard identified in previous
studies. Designated two gynaecologists performed suction abortion under general
anaesthesia. All women were discharged by 13 00 hours.
Results This is an interim report of the initial 290
nullipara and 277 multiparous patients. A total of 54 nullipara and 150
multiparous women had their surgery at 60 minutes of whom 46.3% and 68.0%
respectively did not require dilatation to 8mm Hegar. At 61-120 minutes, 61.9%
and 78.6% of 181 nullipara and 112 multiparous women respectively showed no
resistance to 8 mm or larger Hegar dilator. The corresponding figures for
patients having their operation after 120 minutes were 76.4% and 73.3% of 42
nullipara and 11 multiparous women respectively. A total of 18 nullipara and 2
multiparous women exhibited difficult dilatation. Minor cervical laceration
occurred in only one nullipara patient and required no additional treatment.
Conclusions This study showed that during a dedicated
morning surgical abortion list, adequate cervical priming was achieved in 68.0%
and 46.3% of multiparous and nulliparous women respectively in the first hour of
vaginal misoprostol administration. It contradicts the findings of Sharma et al.1
study. Thus if the list commenced with multiparous women, complications could be
minimized by a planned and staggered theatre times.
Sharma S, Refaey HE, Stafford M, et al. Oral versus vaginal
misoprostol administered one hour before surgical termination of pregnancy: a
randomized controlled trial. BJOG 2005;112:456-60.