Objective: This study aimed to compare sublingual misoprosiol (as a new route of administration) to the vaginal route
for pie-operative cervical priming in vacuum evacuation of first trimester missed abortion.
Design: Prospective randomized clinical study
Setting: Private practice in Domyal city during the period throughout March 2005 lo Septembcr2006.
Methods: Eighty women with missed abortion (fetal death or blighted ova) of gcslational age < 2 weeks were
randomized by a computer-generated model lo receive 400 \ig of misoprosiol (Misotac © SIGMA) either sublinguallj
or vaginally 3 hours prior to manual vacuum aspiration (MVA) using the IPAS bivalve instrument with its plastic
cannulas. The primary outcome measure was the degree of cervical dilatation, and secondary outcomes included the
cervical resistance to dilate from 3-8mm (i.e. poor priming) indicated by the need lo use the traditional mclal Hegar's
dilators instead of the plastic Karman cannulas, inlra-operative blood loss and incidence of pre-operalive side-effects.
Results: There was no significant difference in the baseline cervical dilatation (sublingual: 7.6±l.3 mm; vaginal: 7.7 ±
0.73 mm), cervical resistance lo dilaic from 3 lo 8 mm with plastic Karman cannulas and need lo use mclal Hegar's
dilators with some force (sublingual: 8 cases (20%); vaginal: 7 cases (17.5%). and total blood loss (sublingual-
52.1±20.2 ml; vaginal: 48.3± 12.3ml). Pre-opcrative side-effects were also similar.
Conclusions: Bolh sublingual and vaginal misoprosiol arc effective in cervical priming before surgical termination of
pregnancy in the first trimester. Sublingual misoprosiol has the advantage of being more convenient to administer and
may be more suitable for day surgery.