Second Trimester Abortion Using Prostaglandin E2 Suppositories With or Without Intracervical Laminaria japonica

Abstract

Objective: To compare the abortifacient efficacy of vaginal prostaglandin (PG) E 2 suppositories with and without pretreatment with intracervical PGE 2 gel and Laminaria japonica.Methods: One hundred seventy-five women between 16 and 20 weeks' gestation requesting abortion were divided randomly into three groups. Forty-one received PGE 2 vaginal suppositories alone to induce abortion, 72 had Laminaria placed 24 hours before vaginal PGE 2 , and 62 were given intracervical 0.5 mg PGE 2 gel plus Laminaria 24 hours before vaginal PGE 2 . Maternal demographic characteristics, induction to delivery time, number of suppositories required, and complications were analyzed.Results: The mean maternal age, gravidity, parity, race, and gestational age were similar among groups. Ninety-five percent of all women delivered within 24 hours. The induction to delivery time was significantly longer in the PGE 2only women (mean ؎ standard deviation 689 ؎ ؎ ؎ 319 minutes) compared with that of those receiving PGE 2 plus Laminaria (487 ؎ ؎ ؎ 321 minutes) and PGE 2 plus Laminaria plus gel (547 ؎ ؎ ؎ 374 minutes, P ‫؍‬ ‫؍‬ ‫؍‬ .01). There was a statistically significant difference in the number of suppositories needed to complete the abortion process. The PGE 2 -only group required more suppositories (median three, range 1-8) compared with PGE 2 plus Laminaria (median 3, range 1-3) and PGE 2 plus Laminaria plus gel (median 2.5, range 1-9; P ‫؍‬ .001). Patients in the PGE 2 plus Laminaria plus gel group reported more pain associated with placement (median pain score 4, range 0 -10) compared with PGE 2 plus Laminaria (median 2, range 0 -9; P ‫؍‬ .003). There was a lower incidence of febrile episodes in the PGE 2 -only group (29%) compared with PGE 2 plus Laminaria (68%) and PGE 2 plus Laminaria plus gel (54%, P ‫؍‬ ‫؍‬ ‫؍‬ .002).Conclusion: Placement of Laminaria japonica 24 hours before PGE 2 vaginal suppository-induced abortion resulted in a significantly shorter induction-to-delivery time, and pretreatment with Laminaria japonica decreased the number of suppositories required to complete abortion. Pretreatment with intracervical PGE 2 gel increased pain associated with Laminaria placement and did not improve the efficacy of the procedure. (Obstet Gynecol 1998;92:398 -402.

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

“…Although prostaglandin analogs are established cervical priming agents, osmotic dilators have been significantly used in cervical preparation. Osmotic dilators of both natural and synthetic types have unique properties (19,20). The natural laminaria dilator is produced from the stems of Laminaria japonica or Laminaria digitata.…”