Moistening the new vaginal misoprostol tablets: does it increase the efficacy of cervical priming before manual vacuum aspiration in first-trimester miscarriage? A randomised clinical trial

Abstract

Objectives: The primary objective of our study was to ascertain whether moistening the Brazilian formulation of vaginal misoprostol tablets increases cervical dilation before manual vacuum aspiration (MVA), compared with use of dry misoprostol, in first-trimester miscarriage. The secondary objective was to ascertain whether there was any correlation between vaginal pH and the degree of cervical dilation using a moistened or dry misoprostol tablet.

Methods: In a single-centre, double-blind, randomised trial, 46 patients with first-trimester miscarriage were randomly allocated to treatment with dry or moistened (with 200 µl distilled water) 2 × 200 μg misoprostol tablets.

Results: The median (range) cervical dilation in the wet and dry groups was 8 mm (6–12 mm) and 7 mm (5–10 mm), respectively (p = .06). The median time between misoprostol insertion and carrying out the procedure did not differ between the dry (406 min, range 180–550 min) and wet (448 min, range 180–526 min) groups (p = .1). No correlation was found between vaginal pH and cervical dilation using continuous data (p = .57; r= 0.08; 95% confidence interval −0.02, 0.3) or dichotomous data (pH ≤5/>5; cervical dilation ≥8 mm or <8 mm; p = .8).

Conclusion: No difference was observed in cervical dilation between moistened and non-moistened misoprostol use prior to MVA.

Chinese abstract

目的：本研究的主要目的是确定巴西湿的阴道米索前列醇片与干的米索前列醇片相比, 能否在早孕人工负压吸引流产前促进宫颈成熟。次要目的是当使用湿或干的米索前列醇片时, 确定阴道pH值与宫颈成熟度之间是否有相关性。

方法：采用单中心、双盲、随机试验, 将46例妊娠早期流产患者随机分为干米索前列醇片治疗组或湿米索前列醇片治疗组(200 ml蒸馏水) 2 × 200μg米索前列醇片。

结果：湿米索前列醇片治疗组宫颈管扩张中位数为8mm(6 ∼ 12 mm), 干米索前列醇片治疗组宫颈管扩张中位数为7mm(5 ∼ 10 mm)。干米索前列醇片治疗组(406 min, 180 ∼ 550 min)与湿米索前列醇片治疗组(448 min, 180 ∼ 526 min)相比, 米索前列醇片放入与开始手术的中位数时间两组无差异(p = .1)。用连续数据(p = 0.57；r = 0.08；95%置信区间0.02, 0.3)或二分法数据(pH 5/>5；宫颈扩张8mm或<8mm；p=.8), 发现阴道pH值与宫颈扩张无相关性。

结论：湿米索前列醇与干米索前列醇在MVA前的使用对宫颈管扩张无明显差异。

Keywords:

• Cervical priming
• manual vacuum aspiration
• miscarriage
• misoprostol

Disclosure statement

The authors declare that there is no conflict of interest associated with this manuscript.

Additional information

Funding

This work was supported by the Fundo de Incentivo à Pesquisa e Eventos do Hospital de Clínicas de Porto Alegre (FIPE) under grant 15-0115.