Preparation of the cervix for surgical termination of pregnancy in the first trimester

Worldwide, surgical vacuum aspiration is the method of choice of terminatin g first trimester unwanted pregnancy. Cervical priming prior to surgical ev acuation reduces the risks of cervical injury by making the cervix softer a nd easier to dilate. Over the years, a number of effective methods of cervi cal priming have became available: osmotic dilators; antiprogesterone and p rostaglandins. Of these, prostaglandins remain the most widely used method of cervical preparation. However many of the natural and synthetic analogue s of prostaglandins are either expensive or associated with troublesome sid e-effects. More recently, misoprostol, a synthetic 15-deoxy-16 hydroxy 16-m ethyl analogue of naturally occurring prostaglandin E, used in the manangem ent of peptic ulcers, has established a lead for cervical priming in terms of availability, ease of administration, cost and effectiveness. In fact it appears that both oral and vaginal misoprostol given at dosages of 400 mu g are effective for cervical priming when administered 3 h prior to surgica l vacuum aspiration. Now that the use of misoprostol for cervical priming h as been validated, its widespread use in gynaecological practice is expecte d.