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[Randomized study of sulprostone versus misoprostol in the cervical preparation before elective abortion in
B Schaub1, P Fuhrer, D Sainte-Rose
1Service de Gynécologie-Obstétrique 2, Hôpital Victor-Fouche, CHU de Fort-de-France, Martinique.
Objective:
To assess the effectiveness and side effects of misoprostol versus suprostone in cervix preparation before aspiration abortion in the nullipara.
Methods:
Ninety nulliparous women requesting medical abortion with gestations varying from 7 to 12 weeks were included in a prospective randomized study after informed consent. Women with contraindications for prostaglandins and those consulting before 7 weeks gestation were excluded from the study. The women were assigned to 30 groups randomly: women in group A were given 500 micrograms sulprostone in 250 saline solution infused at a rate of 100 micrograms/h 12 hours before the abortion; women in groupe B were given 400 micrograms misoprostol per os 3 hours before abortion; and women in groupe C were given 400 micrograms misoprostol per os 12 hours before abortion.
Results:
The three groups were not different for age, parity or gestation, gestational age at abortion or type of anaesthesia. Dilatation of the cervix after treatment was identical in groups A and C (8.60 +/- 1.3 vs 8.20 +/- 1.3; NS) but was greater in group A than in group B (8.60 +/- 1.3 vs 7.23 +/- 2.2; p = 0.02). Maximal dilatation was the same in the three groups (9.50 +/- 0.8, 9.10 +/- 1.3, 9.17 +/- 0.8 respectively). Rate of partial expulsion was higher in groups A and C (23 and 6%) compared with group B (0%). Tolerance was much better with misprosol than with sulprostone: 43% digestive disorders in group A versus 15% in groupe B and C (p = 0.003); 80% pelvic pain with sulprostone versus 53% with misoprostol (p = 0.01); 70% metrorrhagie with sulprostone versus 38% with misoprostol (p = 0.04) and 36% with more bleeding than cycles in the sulprostone subjects versus 12% in the misoprostol subjects (p = 0.005).
Conclusion:
Misoprostol at a dose of 400 micrograms per os 12 hours before abortion in the nullipara is an interesting alternative to sulprostone. It is equally effective for cervix dilatation, tolerance is much better and cost is lower.