Is misoprostol the drug of choice for induced cervical ripening in early pregnancy termination?

Background. To study the effectiveness of three different cervical ripening agents in terms of dilatation ability and patient discomfort in connection with legal first trimester abortion. Methods. Three randomized trials among unselected nulliparous women were performed 1: hygroscopic tent versus gemeprost, 2: misoprostol versus gemeprost and 3: misoporstol administered orally 17 versus 10 hours before vacuum curettage was performed. Main outcomes. Dilatation ability, frequent gastrointestinal side effects, severe pain (patients' perception). Results. In trial 1, there was a tendency of a greater dilatation ability using the hygroscopic tent, while the experience of pain was a greater problem with gemeprost. In Trials 2 and 3, there were no significant differences in the dilatation abilities or gastrointestinal patient discomfort. There was a tendency towards a higher demand for narcotic analgesics in patients treated with gemeprost compared with all other groups. Conclusions. Gemeprost and misoprostol showed identical ability to dilate and caused patient-experienced discomfort to the same degree. The use of misoprostol may be preferred as it has the advantage of being both less expensive and easier to administer.