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 Kingdom
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 abortion.
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.
Reference
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.