Is preoperative vaginal cleansing necessary for control of infection after first
trimester vacuum aspiration?
Annette Aronsson MD, Karolinska University Hospital, Division of Gynecology and
Obstetrics, Stockholm, Sweden,
Traditionally, the vagina is cleansed before a vacuum aspiration or a dilatation and
curettage is performed.
In the effort to give evidence based recommendations a review of the literature was
performed to find out if this practice could be supported or safely omitted.
Available data did not support any increased incidence of infections in women who had not
undergone any presurgical cleansing compared to the group of women in which cleansing
Based on the studies reviewed, preoperative cleansing can be safely omitted at first
trimester surgical abortion without risk for the patient, provided that genital infections are
Sublingual compared with oral misoprostol for cervical dilatation prior to vacuum aspiration.
Annette Aronsson*, MD, Lotti Helström, MD. and Kristina Gemzell Danielsson, MD. PhD
Dept of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
BACKGROUND. Vacuum aspiration is still the most common method in late first and early second trimester pregnancy. Prostaglandin analogues have been successfully used for preparing the cervix before mechanical dilatation and suction curettage since over 20 years to reduce the risk of mechanical injury, incomplete evacuation and haemorrhage. The analogue mainly used today is misoprostol. The most advantageous dose schedule for cervical priming seems to be 0.4 mg misoprostol orally or vaginally given 3 hours prior to vacuum aspiration. However most women prefer the oral route. Recently the possibility to administer misoprostol sublingually has been described. The absorption of misoprostol when given sublingually is equally rapid as following oral treatment but the plasma levels remain elevated for a significant longer time and the effect on uterine contractility is more pronounced.
The aim of the study was to compare the effect of oral and sublingual administration of misoprostol for cervical priming prior to vacuum aspiration.
METHODS. Thirty-two first time pregnant women with 8 to 12 weeks amenorrhoea and admitted to the hospital for surgical termination of pregnancy were recruited. The women were randomly assigned to receive 400 mg misoprostol either orally or sublingually 3 hours prior to surgery.
RESULTS. The degree of baseline dilatation and the cumulative force needed for dilatation of the cervical canal did not differ between the two treatment groups. However, the number of patients in whom a strong force (15 and 20 N with the 8 and 9 mm dilator respectively) was significantly higher following oral than following sublingual treatment. The number of patients with gastrointestinal side effects and need of additional analgesic treatment was higher following sublingual treatment. The opposite was true with regard to the number of patients who had a blood loss at operation of 50 ml or more.
CONCLUSION. It was shown that sublingual administration is more effective than oral administration of misoprostol for cervical priming and associated with less blood loss but a higher frequency of side effects.