Buccal misoprostol plus laminaria for cervical preparation before dilation and evacuation at 21-23 weeks of gestation: a randomized controlled trial

Contraception. 2014 Apr;89(4):307-13. doi: 10.1016/j.contraception.2013.10.013. Epub 2013 Nov 4.


Objective: To describe the effectiveness of buccal misoprostol as an adjunct to laminaria for cervical ripening before later second-trimester abortion by dilation and evacuation (D&E).

Methods: A randomized, double-blinded, placebo-controlled trial of 196 women undergoing D&E between 21 and 23 weeks of gestation. Subjects had overnight laminaria and 400 mcg buccal misoprostol or placebo 3-4 h before the abortion. We used logarithmic transformation of the primary outcome--D&E procedure duration--to achieve a normal distribution.

Results: Mean D&E duration was 1.7 min shorter with misoprostol (p=.02). The median duration was 9.7 versus 10.4 min in the misoprostol and placebo groups, respectively (p=.09). Cervical dilation was slightly greater with misoprostol (median 75 mm vs. 73 mm, p=.04); however, physicians did not find the misoprostol D&Es easier to complete. Half of subjects reported severe pain after misoprostol vs. 11% with placebo (p<.001).

Conclusion: Adjuvant buccal misoprostol results in slightly shorter D&Es at the cost of more side effects.

Keywords: Cervical ripening; Induced abortion; Misoprostol; Pain; Second trimester pregnancy.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortifacient Agents, Nonsteroidal / administration & dosage
  • Abortifacient Agents, Nonsteroidal / adverse effects*
  • Abortion, Induced*
  • Administration, Oral
  • Adult
  • Cervical Ripening / drug effects*
  • Double-Blind Method
  • Female
  • Humans
  • Laminaria
  • Misoprostol / administration & dosage
  • Misoprostol / adverse effects*
  • Pregnancy
  • Pregnancy Trimester, Second
  • Young Adult


  • Abortifacient Agents, Nonsteroidal
  • Misoprostol