A Comparative Study of Vaginal Misoprostol and Cervical Catheter for Priming the Cervix in First Trimester Missed Abortions

Abstract

Objective: To compare the effectiveness of cervical catheter and vaginal misoprostol as a cervical priming agent prior to surgical evacuation in first trimester missed abortions in terms of ease with which the conventional procedure of curettage was performed. Design: Quasi-experimental study. Setting: Divisional Headquarters Hospital, Sargodha from 1st June 2007 to 31st December 2008 in a period of one and a half year. Methods: Seventy – four primigravidas having missed abortions of upto thirteen weeks were studied. They were offered intracervical catheter or vaginal misoprostol (400 mcg), 6 hours pre – operatively. Main Outcome Measures: Cervical dilatation, amount of blood loss and time taken for evacuation along with side effects experienced. Results: Cervical dilatation was significantly better in Foleys group as 50% of the patients had dilatation > 10mm as compared to 12% of misoprostol group. P value is 0.01 (significant). Blood loss was negligible in 80% of the Foleys group while 70% of the Misoprostol group had 75 to 100 ml of blood loss and 30% lost up to 200 ml. Time taken to complete the procedure ranged from 4 to 7 minutes. 50% of the Foleys group and 12% of the misoprostol group took 4 minutes. 35% and 37% of the tw0 groups took 5 minutes and 12 % 51% of both groups took 7 minutes consecutively. Conclusion: Both are good priming agents. Cervical catheter is equally effective if not superior to vaginal misoprostol and has lesser side effects. Key words: Misoprostol, Cervical Priming extra-amniotic catheter, missed abortions.