Misoprostol for Cervical Ripening Prior to Manual Vacuum Aspiration (MVA) in Abnormal Uterine Bleeding: Double Blinded Randomized Controlled Trial†

Wongsa Maneesorn MD*, Athita Chanthasenanont MD*, Kornkarn Bhamarapravatana PhD**, Komsun Suwannarurk MD*

Affiliation : † The abstract of this manuscript was presented on October 20-23, 2013 as oral presentation at the 23rd Asian & Oceanic Congress of Obstetrics & Gynaecology (AOCOG 2013), Bangkok, Thailand * Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Department of Preclinical Science, Faculty of Medicine, Thammasat University, Pathumthani, Thailand

Objective : To study the effectiveness of sublingual misoprostol for cervical ripening before MVA in women aged between 35 and 55 years old. Material and Method: Women aged between 35 and 55 years old who had indications for endometrial sampling were recruited. Exclusion criteria were gross pathology of cervix, pregnancy, allergy to misoprostol, and abnormal coagulopathy. Eighty women who had indication for MVA were then assigned by randomization (block of four). Participants were treated with either sublingual 200 μg of misoprostol (study group) or placebo (controlled group) for cervical priming at two hours before procedure. The largest diameter of the Hegar’s dilator through internal os without any resistance before MVA was the primary collected data. Secondary data were operating time, immediate pain score, satisfactory score, complications, and side effects.
Results : Mean age of misoprostol and controlled group were 44.85.2 and 45.55.0 years old, respectively. One third of both groups had previously experienced uterine curettage. The initial cervical diameter before MVA of individuals receiving misoprostol and controlled group were 6.92.0 and 5.52.4 mm, respectively. The MVA time in misoprostol group was significantly shorter than controlled group (5.11.7 vs. 8.03.9 min, p<0.001). The additional analgesia was not different in both groups. Side effect before MVA were more significantly found in misoprostol group (p = 0.001). Lower post MVA pain and satisfactory score were better reported in misoprostol group than placebo’s (p<0.001).
Conclusion : Two hundred micrograms of sublingual misoprostol administration prior to MVA gave significantly effective result of cervical priming. Satisfactory and pain scores were more favorable in misoprostol group with manageable side effects.

Keywords : Manual vacuum aspiration, Misoprostol, Sublingual

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