Is there an optimum time interval from vaginal misoprostol administration to surgical abortion?

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.

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