Buccal misoprostol for cervical ripening prior to first trimester abortion

Background: Cervical priming prior to uterine suction evacuation softens the cervix and lessens the force needed for dilation, thereby potentially reducing the probability of procedural complications. The use of buccal misoprostol has been shown to be an adequate cervical primer in second trimester surgical procedures, but its use in first trimester aspiration procedures is not well documented. Our objective was to assess the necessity of manual dilation of the cervix when buccal misoprostol is used for cervical priming prior to first trimester uterine aspiration procedures. Study Design: Retrospective case review of 685 patients who underwent a first trimester aspiration abortion with buccal misoprostol cervical priming from August 24, 2006, to February 23, 2007. All procedures were performed by three experienced physicians. Results: Adequate dilatation of the cervix was achieved in 44.2% patients. The proportion of patients with adequate dilation decreased with increasing gestational age. Patients requiring additional mechanical dilatation differed significantly between those who were parous (51.0%) and those who were nulliparous (72.4%) (p<.001). Conclusion: Buccal misoprostol appeared to decrease our need for manual dilation prior to first trimester aspiration abortion. Earlier gestations and parous patients showed less need for manual dilitation than later gestations or nulliparous women. A larger study with a control group is needed to confirm the benefit of the use of buccal misoprostol in first trimester aspiration abortion.