ABSTRACT Background: The optimal regimen has still to be determined for the use of misoprostol in the surgical termination of pregnancy in the early second trimester. Objective: To compare the outcomes of two different regimens for cervical priming with misoprostol before dilatation and evacuation (D & E) in 13 weeks - 16 weeks gestation pregnancy terminations. Methods: A retrospective analysis was performed of the medical records of two cohorts of 334 women each who were treated with either 3 sublingual doses of 2 misoprostol 200 µg tablets 30 minutes apart on admission or the same dosage preceded by 1 oral tablet of misoprostol 200 µg at home 3 hours before admission. Results: The addition of the home tablet of misoprostol increased the rate of one day completion of D & E from 97.3% to 100% (P = 0.004), and the overall mean theatre time for D&E was reduced by 12.3% in parous women (P = 0.001) and 6.4% in nulliparous women (P = 0.003) with the reduction being consistent across all gestations. Conclusions: This retrospective study showed that the addition of 1 oral tablet of misoprostol 200 µg at home 3 hours before admission to a regimen of 3 sublingual doses of 2 misoprostol 200 µg tablets 30 minutes apart on admission significantly increases the probability of all women at 13 weeks - 16 weeks gestation completing a termination of pregnancy in one day with a single D & E procedure and with a reduced theatre time.
Cite this paper
nullChambers, D. , Willcourt, R. , Laver, A. , Baird, J. and Herbert, W. (2011) Comparison of two misoprostol regimens for cervical priming before surgical pregnancy termination at 13 to 16 weeks gestations. Open Journal of Obstetrics and Gynecology, 1, 187-190. doi: 10.4236/ojog.2011.14036.
 Gamble, S.B., Strauss, L.T., Parker, W.Y., Cook, D.A., Zane, S.B. and Hamdan, S. (2008) Centers for disease control and prevention (CDC). Abortion Surveillance-United States 2005. MMWR Surveillance Summaries, 57, 1-32.
 Aronsson, A., Bygdeman, M. and Gemzell-Danielsson, K. (2004) Effects of misoprostol on uterine contractility following different routes of administration. Human Reproduction, 19, 81-84. doi:10.1093/humrep/deh005
 Chambers, D.G., Mulligan, E.C., Laver, A.R., Weller, B.K., Baird, J.K. and Herbert, W.Y. (2009) Comparison of four perioperative misoprostol regimens for surgical termination of first-trimester pregnancy. International Journal of Gynecology and Obstetrics, 7, 211-215.
 Pridmore, B.R. and Chambers, D.G. (1999) Uterine perforation during surgical abortion: Review of diagnosis, management and prevention. Australian and New Zealand Journal of Obstetrics and Gynaecology, 39, 349-353. doi:10.1111/j.1479-828X.1999.tb03413.x
 Chambers, D.G., Willcourt, R.J., Laver, A.R., Baird, J.K. and Herbert, W.Y. (2011) Comparison of Dilapan-S and laminaria tents for cervical priming before surgical pregnancy termination at 17 to 22 weeks gestations. International Journal of Women’s Health, 3, 347-352.
 Wilson, L.C., Meyn, L.A. and Creinin, M.D. (2011) Cervical preparation for surgical abortion between 12 and 18 weeks of gestation using vaginal misoprostol and Dilapan-S. Contraception, 8, 511-516.
 Lohr, P.A., Hayes, J.L. and Gemzell-Danielsson, K. (2008) Surgical versus medical methods for second trimester induced abortion. Cochrane Database Systematic Reviews, 1, CD006714.
 Carbonell, J.L., Gallego, F.G., Lorente, M.P., Bermudez, S.B., Sala, E.S., Gonzalez, L.V. and Texido, C.S. (2007) Vaginal vs. sublingual misoprostol with mifepristone for cervical priming in second-trimester abortion by dilatation and evacuation: A randomized clinical trial. Contraception, 75, 230-237.
 Newman, S.J., Dalve-Endres, A., Diedrich, J.T., Steinauer, J.E., Meckstroth, K. and Drey, E.A. (2010) Cervical preparation for second trimester dilatation and evacuation. Cochrane Database Systematic Reviews, 8, CD007310.
 Nucatola, D., Roth, N., Saulsberry, V. and Gatter, M. (2008) Serious adverse events associated with the use of misoprostol alone for cervical preparation prior to early second trimester surgical abortion (12 weeks - 16 weeks). Contraception, 78, 245-248.