Human Reproduction, Vol. 14, No. 6, 1635-1637,
June 1999
© 1999 European Society of Human Reproduction and Embryology
Does an acidic medium enhance the efficacy of vaginal misoprostol for pre-abortion cervical priming?
1 Department of Obstetrics and Gynaecology, National University of Singapore, Singapore and 2 Biostatistics Consultancy Unit,National University of Singapore Medical Institute, Singapore
Absorption pharmacokinetics reveal a relationship between plasma concentrations of misoprostol and its therapeutic effect. To achieve a constant plasma profile and optimal efficacy, it is important to develop a medium that ensures complete dissolution of vaginal misoprostol tablets. Vaginal misoprostol is said to liquefy better in an acidic medium; thus, the aim of this study was to determine whether a 200 µg misoprostol tablet dissolved in acetic acid would be more efficacious than 200 µg misoprostol dissolved in water for pre-abortion cervical priming. A total of 120 healthy nulliparous women requesting legal termination of pregnancy between 6–12 weeks gestation were allocated randomly to either of the study groups. Vacuum aspiration was performed 3–4 h after insertion of the misoprostol tablet. Using Hegar's dilator, the degree of cervical dilatation before operation was measured. Of 60 women, 14 (23%) achieved a cervical dilatation of 
8 mm when the misoprostol dose was dissolved in acetic acid; 12 (20%) achieved a similar cervical dilatation when the dose was dissolved in water. The mean cervical dilatation for the acid and water media used was 6.3 mm and 6.2 mm respectively; these differences were not statistically significant, neither were pre-operative and intra-operative blood losses statistically different between the two groups. Twenty-four (40%) and four (7%) respectively of women in whom a water medium was used experienced vaginal bleeding and abdominal pain; 20 (33%) and 0 women respectively among those in whom an acetic acid medium was used experienced vaginal bleeding and abdominal pain. These differences in side effects were not statistically significant. Our study shows that the use of acetic acid to dissolve vaginal misoprostol does not improve the efficacy in achieving successful cervical dilatation for pre-abortion cervical priming.
Key words: acetic acid/pre-abortion cervical priming/vaginal misoprostol
3 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, National University Hospital,Lower Kent Ridge Road, Singapore 119074
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