A randomised clinical trial comparing thesublingual and buccal routes of administration ofmisoprostol after mifepristone for medicaltermination of pregnancy of up to 63 days ofgestation

Abstract

Objective: Buccal misoprostol 800 mcg and sublingual 800 mcgshow high efficacy when used with 200 mg mifepristone for earlypregnancy termination but with different profiles of side effects.This is the first double-blind randomized trial comparing thesetwo routes for termination of early pregnancies up to 63 daysgestation.Methods: Eligible women (n = 90) who requested legaltermination of pregnancy up to 63 days gestation wererandomized to two groups and given 200 mg of oral mifepristonefollowed 48 h later by either 800 mcg of sublingual (n = 45) orbuccal (n = 45) misoprostol.Results: Similar proportion of women experienced fever insublingual and buccal groups (37.8% vs. 22.2%, P = 0.107). Theincidence of chills was significantly higher in the sublingual group(55.6% vs. 91.1%, P = 0.0001). Complete termination ofpregnancy occurred in 95.4% (95% CI: 84.9–99.5) of women inthe buccal group and 97.8% (95% CI: 88.2–99.9) in the sublingualgroup. Conclusions: When combined with mifepristone for terminationof pregnancy up to 63 days, sublingual administration ofmisoprostol is associated with more chills but not other sideeffects when compared with buccal administration.