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

Objectives: 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.