Application of vaginal misoprostol before cervical dilatation to facilitate first-trimester pregnancy interruption

To study the capacity of vaginal misoprostol to soften the cervix and facilitate cervical dilatation in women undergoing first-trimester pregnancy interruption.

We performed a double-blind, placebo-controlled study in 100 women opting for voluntary pregnancy interruption. The subjects were randomly allocated to two treatment groups, receiving either 200 micrograms misoprostol or placebo in the posterior vaginal fornix 6 hours before cervical dilatation. We noted the number of women with vaginal bleeding, with chorionic tissue in the vagina, or with no resistance to a Hegar 8 dilator, and recorded the total time in minutes for pregnancy interruption.

Vaginal bleeding from the cervix occurred in 70% of the misoprostol group and in 8% of the placebo group (odds ratio 26.83; 95% confidence interval [CI] 9.73-74.00). Almost one-fourth (22%) of the misoprostol-treated women had chorionic tissue in the vagina, compared to one woman (2%) in the placebo group (odds ratio 13.82; 95% CI 2.59-73.61). Cervical dilatation was achieved in 74 and 10% of the misoprostol- and placebo-treated women, respectively (odds ratio 25.62; 95% CI 9.61-68.28). The time required for pregnancy interruption was significantly shorter with misoprostol (P < .004).

Misoprostol is significantly more effective in facilitating cervical dilatation than is placebo. The average intervention time for pregnancy interruption was reduced by 35%.