CERVICAL PRIMING PRIOR TO FIRST TRIMESTER SUCTION EVACUATION: COMPARATIVE STUDY

BACKGROUND: Suction evacuation is widely used method for elective termination of pregnancy in first trimester. The step of mechanical cervical dilatation during this procedure is probably the most critical step. Difficult cervical dilatation may cause incomplete evacuation, cervical laceration, and uterine perforation. Prior cervical priming with pharmacological agents like prostaglandin derivatives although not free from side effects, makes the procedure easier with reduced overall complication rate, and hence recommended in several guidelines. AIM: We compared, two prostaglandin derivatives, sublingual Misoprostol (15-deoxy-16hydroxy16methylprostaglandinE1) with intramuscular Carboprost (15-methylProstaglandinF2a.) for cervical priming prior to suction evacuation in first trimester termination of pregnancy. SETTINGS AND DESIGN: Prospective study was conducted at tertiary care institute in Mumbai. METHODS: Eighty women requesting pregnancy termination from 6thto12thweeks gestation were randomized in two groups. Two hours prior to suction evacuation, first group (N=40) received 400 mu g of sublingual Misoprostol, while second group (N=40) received 250 mu g of intramuscular injection Carboprost. Outcomes of both groups were recorded in terms of baseline cervical dilatation, immediate complications, drug induced side effects and patient acceptability by questionnaire. STATISTICAL ANALYSIS: Performed by SPSS Inc, Version 15, Continuous variables were compared using ttest/ANOVA. Categorical variables were compared by Chi-Square test or Fisher exact test. Probability value<0.05 was considered statistically significant. RESULTS: Mean baseline cervical dilatation prior to suction evacuation was7.645+/-1.20mm in the Misoprostol group and 7.724+/0.64mm in the Carboprost group (P>0.05). 42.5% women in Misoprostol group had cervical dilatation > 8mm, compared to 17.5% in Carboprost group (P-0.004). The side effects including nausea, vomiting and abdominal cramps were more in Carboprost group as compared to Misoprostol group. No patient had diarrhea in Misoprostol group as against 32.5% in Carboprost group (P<0.0001). There were no complications like in complete evacuation, cervical lacerations or uterine perforation noted in either group. CONCLUSION: Cervical priming prior to suction evacuation results in easier dilatation reducing the incidence of complications. Sublingual Misoprostol appears to be more effective with minimal side effects hence, easily acceptable alternative as compared to intramuscular Carboprost.