Objective: Our purpose was to determine whether intracervical placement of laminaria tents would improve the effectiveness of the prostaglandin analog misoprostol for the elective termination of pregnancies in the second trimester.
Study design: Sixty-eight women between 12 and 22 weeks of gestation with either an intrauterine fetal death (n = 40) or medical or genetic indications for pregnancy termination (n = 30) were randomized to receive 200 micrograms of misoprostol administered vaginally every 12 hours with or without intracervical placement of laminaria concurrently with the first dose of misoprostol.
Results: The rate of abortion 24 hours after initiation of treatment was 69.7% in the 33 women receiving misoprostol alone and 68.6% in the 35 women treated with misoprostol and laminaria. The abortion rates 48 hours after initiation of treatment were 84.8% and 91.4%, respectively, an insignificant difference. The complete abortion rate was also similar between women receiving misoprostol alone (39.3%) and the group receiving misoprostol and laminaria (37.5%). There were no significant differences in the incidence of fever, vomiting, diarrhea, or pain. The mean interval from initiation of treatment to abortion was also similar, 15.7 hours in those receiving misoprostol alone and 17.4 hours in those treated with misoprostol and laminaria. In both groups women who had live fetuses at the start of the procedure had a higher failure rate of abortion and a longer time interval to abortion than women whose fetus was dead.
Conclusions: Laminaria tents inserted concurrently with the first dose of misoprostol do not significantly improve the abortifacient effect of vaginal misoprostol in the second trimester of pregnancy.
PIP: The authors conducted a study to determine whether the intracervical placement of laminaria tents would improve the effectiveness of the prostaglandin analog misoprostol for the elective termination of pregnancies in the second trimester. 68 women at 12-22 weeks of gestation with either an intrauterine fetal death or medical or genetic indications for pregnancy termination were randomized to receive 200 mcg of misoprostol administered vaginally every 12 hours with or without the intracervical placement of laminaria concurrently with the first dose of misoprostol. There was a 69.7% rate of abortion 24 hours after the initiation of treatment in the 33 women who received misoprostol alone and 68.6% in the 35 women treated with both misoprostol and laminaria. Abortion rates 48 hours after the initiation of treatment were 84.8% and 91.4%, respectively, an insignificant difference. The complete abortion rate was 39.3% among women who received misoprostol alone and 37.5% among women who received both misoprostol and laminaria. There were no significant differences between the two groups in the incidence of fever, vomiting, diarrhea, or pain. The mean interval from the initiation of treatment to abortion was 15.7 hours among women who received misoprostol alone and 17.4 hours among women who received both misoprostol and laminaria. In both groups, women who had live fetuses at the start of the procedure had a higher failure rate of abortion and a longer time interval to abortion than women whose fetus was dead. These findings indicate that the insertion of laminaria tents concurrent with the first dose of misoprostol does not significantly improve the abortifacient effect of vaginal misoprostol during the second trimester of pregnancy.