Comparison of two misoprostol regimens for cervical priming before surgical pregnancy termination at 13 to 16 weeks gestations

Background: The optimal regimen has still to be determined for the use of misoprostol in the surgical termination of pregnancy in the early second trimester. Objective: To compare the outcomes of two different regimens for cervical priming with misoprostol before dilatation and evacuation (D & E) in 13 weeks - 16 weeks gestation pregnancy terminations. Methods: A retrospective analysis was performed of the medical records of two cohorts of 334 women each who were treated with either 3 sublingual doses of 2 misoprostol 200 µg tablets 30 minutes apart on admission or the same dosage preceded by 1 oral tablet of misoprostol 200 µg at home 3 hours before admission. Results: The addition of the home tablet of misoprostol increased the rate of one day completion of D & E from 97.3% to 100% (P = 0.004), and the overall mean theatre time for D&E was reduced by 12.3% in parous women (P = 0.001) and 6.4% in nulliparous women (P = 0.003) with the reduction being consistent across all gestations. Conclusions: This retrospective study showed that the addition of 1 oral tablet of misoprostol 200 µg at home 3 hours before admission to a regimen of 3 sublingual doses of 2 misoprostol 200 µg tablets 30 minutes apart on admission significantly increases the probability of all women at 13 weeks - 16 weeks gestation completing a termination of pregnancy in one day with a single D & E procedure and with a reduced theatre time.