UTERINE EVACUATION BY VAGINAL MISOPROSTOL AFTER 2ND TRIMESTER PREGNANCY INTERRUPTION

Background. The purpose was to study the capacity of vaginal misoprost ol in combination with methylergometrine to achieve complete evacuatio n of the uterus without ensuing surgical evacuation of the uterine cav ity. Methods. We performed this trial on 228 women seeking pregnancy i nterruption. Vaginal misoprostol was given in a dosage of 800 mu g in early second trimester. All women received concomitant treatment with peroral methylergometrine from the moment of misoprostol application e very 8 hours until uterine evacuation. Follow-up was continued until t he first menstruation after interruption. Results. Complete uterine ev acuation was achieved in 173/228 cases (76%) [group 1]. The remaining 55 women [group 2] underwent manual evacuation of placental remnants t rapped in the cervix. In seven of these women a conventional curettage was carried out due either to ultrasound evidence of placental remnan ts or due to uterine bleeding. The interval between misoprostol applic ation and fetal expulsion averaged 14.9 hours (s.d. 9.6) in group 1 an d 21.0 hours (s.d. 14.5) in group 2 (p=0.006). Conclusions. Misoprosto l, in combination with methylergometrine, is a remarkably efficient dr ug in achieving uterine evacuation also in the absence of surgical eva cuation of the uterine cavity. The present study provides justificatio n for a more expectant attitude after vaginal misoprostol treatment fo r pregnancy interruption. The avoidance of close to 80% of otherwise c onventional curettages would seem to represent a major advantage, part icularly in settings where manpower and material resources are scarce. (C) Acta Obstet Gynecol Scand 1996