Delayed Administration of Carboprost Methylate Reduces Perioperative Complications Without Affecting Cervical Ripening Effect in Surgical Abortion: A Randomized Controlled Trial.

AIM: This study aimed to investigate whether optimizing the timing of vaginal administration of carboprost methylate (CM), a prostaglandin F2α analogue, could ensure surgical safety and effectiveness while minimizing its side effects.

METHODS

This randomized controlled trial included 120 patients undergoing surgical abortion who were equally divided into two groups in a tertiary hospital. Group A received CM about 2 h before surgery, while group B received the medication just before anesthesia. The primary outcome was the cervical dilation time and the secondary outcomes included parameters of surgery completeness (surgery time, blood loss, and first-pass success rate of 7.5 Hegar dilator) and adverse events (abdominal pain, vomiting, nausea, diarrhea, defecation urgency, and fever).

RESULTS

The cervical dilation time and parameters of surgery completeness were similar between the two groups, and the concentration of cervical matrix metalloproteinase was no different. However, adverse events related to CM were significantly lower in group B than in group A (93.4% vs. 28.8%, p < 0.01) before anesthesia. The abdominal pain numerical rating scale (NRS) score before anesthesia was 10 times higher in group A (2.84 ± 2.11 vs. 0.27 ± 0.53, p < 0.01). Postoperative vomiting and nausea (PONV) percentage were significantly lower in group B (6.7% vs. 19.0%, p = 0.04).

CONCLUSION

Delayed administration of CM until before anesthesia is effective in cervical priming for surgical abortion in early pregnancy and significantly reduces adverse symptoms, including PONV, diarrhea, and abdominal pain.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT05834361.