Randomized Controlled Trial Comparing Efficacy between Vaginal Misoprostol versus Combined Oral plus Vaginal in First-Trimester Missed Abortion before Surgical Evacuation

Abstract

Surgical evacuation is still the standard management for termination of pregnancy in the first trimester. Although rare, the complications associated with surgical evacuation can affect the reproductive health of a substantial number of women. This procedure is associated with complications such as excessive hemorrhage, incomplete abortion and cervical tear. The risk is increased when difficulty is encountered during cervical dilatation especially in nulliparous patients. Cervical priming before surgical termination of first trimestric pregnancy has been proved in many former studies to decrease the risk of complications of this surgical procedure. Prostaglandin analogues are the cervical priming agents of choice and misoprostol has been studied for this purpose. Both vaginal, oral and oral plus vaginal administrations were found to be useful,however, oral administration is more convenient. The purpose of this study was to evaluate the use of vaginal misoprostol to achieve pre-operative cervical ripening in comparison to vaginal plus oralmisoprostol in missed abortion in the first trimester. 110 patients with missed abortion in the first trimester were included in this study,they were randomly allocated to one of two groups. In the first group 55 patients were given vaginal misoprostol and oral placebo in order to induce pre-operative cervical ripening. In the second group 55 patients Summary 94 were given oral plus vaginal misoprostol and vaginal placebo for the same purpose and used for comparison. Concerning the pelvic pain during cervical ripening we found that the mean pain score in group 1 was = 59 ± 21 at numerical pain score and in group 2 was = 42 ± 18 at