Prospective Study of Laminaria, Vaginal Misoprostol, and Mechanical Dilator Applications Before Surgical Intervention in First-trimester Pregnant Women with Missed Abortion

Abstract

Objective: We aimed to compare the efficacies of laminaria, vaginal misoprostol, and mechanical dilator applications before surgical intervention with regard to the optimal cervical dilation and severity of pain in first-trimester pregnant women with missed abortion. Materials and Methods:The prospective study included a total of 103 patients with a diagnosis of missed abortion in the sixth-tenth gestational week randomly divided into 3 groups of 400 µg vaginal misoprostol, luminaria, or mechanical dilator applications for the dilation of the cervix before surgical intervention. The effects of laminaria and vaginal misoprostol on the cervical ripening for surgical intervention were evaluated using the Hegar test. Visual analog scale (VAS) values were evaluated during the first application, throughout the period of their applications, and after the surgical intervention.Results: The cervical dilation was found to be similar in the laminaria and vaginal application groups (p=0.64). During the first application, laminaria caused more pain than misoprostol but the difference was not statistically significant (p=0.28). Throughout the period of application and after the surgical intervention, although there was less pain with respect to VAS values after laminaria application, this was not statistically significant (p=0.11). The VAS values after the surgical intervention was determined to be statistically higher after mechanical dilatation compared to other procedures (p=0.001). Conclusion:Laminaria provides cervical preparedness similar to intracervical misoprostol without increasing the side effects in the management of first-trimester pregnant women with missed abortion.