Comparison of oral and vaginal misoprostol for cervical ripening before evacuation of first trimester missed miscarriage.

OBJECTIVE To assess the effectiveness of misoprostol in cervical ripening before evacuation of conception in the first trimester missed miscarriages, and to compare between oral and vaginal routes of administration. METHODS A randomized controlled study was carried out in Baghdad Teaching Hospital, Baghdad, Iraq in 2006. One hundred and twenty women with first trimester missed miscarriages were divided into 2 study groups, randomized for oral and vaginal 400 mcg misoprostol priming of cervix, and 2 control groups randomized for oral and vaginal placebo, before undergoing surgical evacuation of conception after 3 hours. Measured outcomes were: post medication cervical dilatation, time needed to dilate the cervix surgically, blood loss, and development of the side effects of misoprostol. RESULTS Post medication cervical dilatation was higher in the misoprostol group (7.07 +/- 1.36 mm for oral misoprostol, 7.77 +/-1.22 mm for vaginal misoprostol), versus the control groups (2.43 +/- 0.5 mm). Post medication cervical dilatation was significantly higher in the vaginal misoprostol group, compared to the oral group (p=0.04). The time required to dilate the cervix in the misoprostol group was shorter, compared with placebo. There were no significant differences in the amount of blood loss between oral (p=0.74), and vaginal misoprostol groups (p=0.62), and gastrointestinal side effects were significantly more in the oral misoprostol group (p=0.014). CONCLUSION Misoprostol is an effective cervical priming agent when administered either orally or vaginally before evacuation of conception in the termination of the first trimester missed miscarriage.