APPLICATION OF VAGINAL MISOPROSTOL BEFORE CERVICAL DILATATION TO FACILITATE FIRST-TRIMESTER PREGNANCY INTERRUPTION

Objective: To study the capacity of vaginal misoprostol to soften the cervix and facilitate cervical dilatation in women undergoing first-tr imester pregnancy interruption. Methods: We performed a double-blind, placebo-controlled study in 100 women opting for voluntary pregnancy i nterruption. The subjects were randomly allocated to two treatment gro ups, receiving either 200 mu g misoprostol or placebo in the posterior vaginal fornix 6 hours before cervical dilatation. We noted the numbe r of women with vaginal bleeding, with chorionic tissue in the vagina, or with no resistance to a Hegar 8 dilator, and recorded the total ti me in minutes for pregnancy interruption. Results: Vaginal bleeding fr om the cervix occurred in 70% of the misoprostol group and in 8% of th e placebo group (odds ratio 26.83; 95% confidence interval [CI] 9.73-7 4.00). Almost one-fourth (22%) Of the misoprostol-treated women had ch orionic tissue in the vagina, compared to one woman (2%) in the placeb o 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). Conclusion: Misoprostol is significantly more effective in facilitating cervical dilatation than is placebo. The average interven tion time for pregnancy interruption was reduced by 35%.