Sublingual misoprostol prior to manual vacuum aspiration for reducing blood loss at 8-12 weeks of gestation: a randomized double-blind placebo-controlled study.

Aim of the study was to evaluate effect of sublingual misoprostol given prior to manual vacuum termination (MVA) of gestation. 349 healthy women with a normal intrauterine pregnancy at 8 and 12 weeks of gestation were studied. 175 women were randomly allocated to misoprostol group and 174 women to placebo group. The patients received 400 microg misoprostol sublingually or the same amount placebo approximately one hour before the procedure. The mean gestational age were 9,9 (SD 1,4) in the intervention group and 9,8 weeks (SD 1,3) in the control group. The mean age of patients was 27,3 years in both groups. The parity and abortion frequency were 5,7 (SD 4,3) and 3,2 (SD 3,8) in the intervention group and 4,9 (SD 2.8) and 2,5 (SD 2,4) in the control group respectively. The preoperative cervical dilatation were 8,9 mm (SD 1,8) in misoprostol group vs. 6,2 mm (SD 1,5) in placebo group (p<0,001). The amount of blood loss were - 95,0+/-89,3 in misoprostol group vs. 149,0+/-82,1 in placebo group (p<0,001). Need for oxytocin was less common in misoprostol group - 29 (16,6%) vs. 63 (36,2%). The duration of the procedure - 7,3 min (SD 2,7) in misoprostol group vs. 7,7 min (SD 2,2) in placebo group (p=NS). There was no significant difference in terms of visual analogue scores during the procedure, patient satisfaction, and rate of side effects among the groups. Obtained results has shown that sublingual administration of 400 microg misoprostol at least an hour before MVA for termination of pregnancy facilitates the abortion procedure by decreasing the need for cervical dilatation, reducing blood loss and need for oxytocin use. However there was no significant difference in operating time between the two groups. Sublingual misoprostol has the advantage of being more convenient to administer and may be more suitable for day surgery. Further studies could assess optimal route, dose, time interval of misoprostol administration which would provide a faster and a higher effect required for blood loss decrease and cervical priming before abortion.