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Misoprostol Compared With Laminaria Before Early Second-Trimester Surgical Abortion: A Randomized Trial

From the Department of Obstetrics and Gynecology Brigham and Women's Hospital and Harvard Medical School and Planned Parenthood League of Massachusetts Inc, Boston Massachusetts; and the Department of Obstetrics, Gynecology, and Reproductive Sciences and the Center for Reproductive Health Research and Policy, San Francisco General Hospital, University of California, San Francisco, California.

Objective: To compare the efficacy and acceptability of same-day misoprostol and overnight laminaria for cervical ripening before early second-trimester surgical abortion.

Methods: We performed a randomized, double-blinded, controlled trial comparing 400 µg of vaginal misoprostol, given 3–4 hours preoperatively, with overnight laminaria before early second-trimester surgical abortion among women at 13.0–16.0 weeks of gestation (n = 84). The primary outcome was procedure time, and the sample size was based on 95% power to detect a difference of 4.5 minutes between groups. Secondary outcomes included completion of the procedure on the first attempt, procedural difficulty, and patients' pain scores and preferences.

Results: The average gestational duration was 14 weeks 6 days. Procedures performed after laminaria were significantly faster than those after misoprostol (median 3.4 versus 7.2 minutes, respectively, P = .01). Laminaria patients had significantly greater dilation than misoprostol patients at abortion (mean 43 versus 33 French, P < .001), and more misoprostol patients required additional dilation (85% versus 21%, P < .001). Physicians rated 27% of the misoprostol procedures as moderate-markedly difficult versus 5% of laminaria procedures (P = .01). Differences in efficacy were pronounced among nulliparous patients. There were no significant differences in ability to complete the procedure on the first attempt or patients' intraoperative pain scores. More women in the misoprostol group would choose their assigned method again (93% versus 62%, P < .01), and 82% of all subjects preferred a 1-day procedure.

Conclusion: Early second-trimester abortions take longer and are technically more challenging after cervical ripening with same-day misoprostol than with overnight laminaria, but patients prefer same-day misoprostol.

Level of Evidence: I

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				J. Collins Which Randomized Controlled Trials Are Relevant to Clinical Practice? Obstet. Gynecol., August 1, 2005; 106(2): 216 - 218. [Full Text] [PDF]