2ND-TRIMESTER ABORTION USING PROSTAGLANDIN-E-2 SUPPOSITORIES WITH OR WITHOUT INTRACERVICAL LAMINARIA-JAPONICA - A RANDOMIZED STUDY

Objective: To compare the abortifacient efficacy of vaginal prostaglan din (PG) E-2 suppositories with and without pretreatment with intracer vical 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 ho urs before vaginal PGE(2), and 62 were given intracervical 0.5 mg PGE( 2) gel plus Laminaria 24 hours before vaginal PGE(2). Maternal demogra phic characteristics, induction to delivery time, number of suppositor ies required, and complications were analyzed. Results: The mean mater nal age, gravidity, parity, race, and gestational age were similar amo ng groups. Ninety-five percent of all women delivered within 24 hours. The induction to delivery time was significantly longer in the PGE(2) only women (mean +/- standard deviation 689 +/- 319 minutes) compared with that of those receiving PGE(2) plus Laminaria (487 +/- 321 minut es) and PGE(2) plus Laminaria plus gel (547 +/- 374 minutes, P = .01). There was a statistically significant difference in the number of sup positories needed to complete the abortion process. The PGE(2)-only gr oup required more suppositories (median three, range 1-8) compared wit h PGE(2) plus Laminaria (median 3, range 1-3) and PGE(2) plus Laminari a plus gel (median 2.5, range 1-9; P = .001). Patients in the PGE(2) p lus Laminaria plus gel group reported more pain associated with placem ent (median pain score 4, range 0-10) compared with PGE(2) plus Lamina ria (median 2, range 0-9; P = .003). There was a lower incidence of fe brile episodes in the PGE(2)-only group (29%) compared with PGE(2) plu s Laminaria (68%) and PGE(2) plus Laminaria plus gel (54%, P = .002). Conclusion: Placement of Laminaria japonica 24 hours before PGE(2) vag inal suppository-induced abortion resulted in a significantly shorter induction-to-delivery time, and pretreatment with Laminaria japonica d ecreased the number of suppositories required to complete abortion. Pr etreatment with intracervical PGE(2) gel increased pain associated wit h Laminaria placement and did not improve the efficacy of the procedur e. (Obstet Gynecol 1998;92:398-402. (C) 1998 by The American College o f Obstetricians and Gynecologists.)