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  • Title: Comparison of vaginal misoprostol and gemeprost as pre-treatment in first trimester pregnancy interruption.
    Author: Henry AM, Haukkamaa M.
    Journal: Br J Obstet Gynaecol; 1999 Jun; 106(6):540-3. PubMed ID: 10426610.
    Abstract:
    OBJECTIVE: To compare the effectiveness of vaginal misoprostol pre-treatment with standard gemeprost pre-treatment in first trimester pregnancy termination. DESIGN: A prospective randomised study. POPULATION: One hundred and ninety-nine women scheduled for day case termination of pregnancy during the first trimester. METHODS: Cervical priming with a vaginally applied 200 microg tablet of misoprostol for at least four hours, compared with a 1.0 mg vaginal suppository of gemeprost for at least three hours before vacuum aspiration. MAIN OUTCOME MEASURES: The prostaglandin effect on baseline cervical dilatation was the main outcome. Others were occurrence of pre-operative pain and need for analgesia, pre-operative side effects such as nausea, vomiting and diarrhoea, presence of blood in the vagina and blood loss during the operation. RESULTS: There was no significant difference in the dilatation ability of misoprostol or gemeprost, nor in the pre-operative use of analgesics. The frequency of nausea and diarrhoea was significantly less common in the misoprostol treated women. CONCLUSIONS: Vaginally applied misoprostol is as effective as gemeprost in cervical priming prior to first trimester vacuum aspiration. Misoprostol was associated with fewer side effects than gemeprost. The effectiveness of vaginal misoprostol pretreatment in first-trimester abortion was compared with that of the standard gemeprost pretreatment regimen in a prospective randomized study conducted at Helsinki City Maternity Hospital (Finland) during 1996-97. 188 women scheduled for vacuum aspiration abortion were assigned to undergo cervical priming with a vaginally applied 200 mcg tablet of misoprostol for at least 4 hours (n = 95) or a 1 mg gemeprost vaginal suppository for at least 3 hours (n = 93). The mean duration of prostaglandin pretreatment was 221 minutes in the gemeprost group and 288 minutes in the misoprostol group. 14% of women in the gemeprost group and 5% in the misoprostol group needed pain medication. There were no uterine perforations, cervical ruptures, or incomplete evacuations in either group. Nausea and diarrhea were significantly more frequent in the gemeprost group. The effects of the two analogues were similar in terms of cervical softening, as determined by baseline cervical dilatation, and the presence of blood in the vagina. Overall, the misoprostol treatment was found to be as effective as the more costly gemeprost regimen, with even fewer side effects. Use of a 400 mcg vaginal dose of misoprostol could be considered to reduce the time required to reach peak plasma concentrations.
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