title: Misoprostol compared with laminaria before early second-trimester surgical abortion: a randomized trial.
abstract: OBJECTIVE
  To compare the efficacy and acceptability of same-day misoprostol and overnight laminaria for cervical ripening before early second-trimester surgical abortion.
  
  
  METHODS
  We performed a randomized, double-blinded, controlled trial comparing 400 microg of vaginal misoprostol, given 3-4 hours preoperatively, with overnight laminaria before early second-trimester surgical abortion among women at 13.0-16.0 weeks of gestation (n = 84). The primary outcome was procedure time, and the sample size was based on 95% power to detect a difference of 4.5 minutes between groups. Secondary outcomes included completion of the procedure on the first attempt, procedural difficulty, and patients' pain scores and preferences.
  
  
  RESULTS
  The average gestational duration was 14 weeks 6 days. Procedures performed after laminaria were significantly faster than those after misoprostol (median 3.4 versus 7.2 minutes, respectively, P = .01). Laminaria patients had significantly greater dilation than misoprostol patients at abortion (mean 43 versus 33 French, P < .001), and more misoprostol patients required additional dilation (85% versus 21%, P < .001). Physicians rated 27% of the misoprostol procedures as moderate-markedly difficult versus 5% of laminaria procedures (P = .01). Differences in efficacy were pronounced among nulliparous patients. There were no significant differences in ability to complete the procedure on the first attempt or patients' intraoperative pain scores. More women in the misoprostol group would choose their assigned method again (93% versus 62%, P < .01), and 82% of all subjects preferred a 1-day procedure.
  
  
  CONCLUSIONS
  Early second-trimester abortions take longer and are technically more challenging after cervical ripening with same-day misoprostol than with overnight laminaria, but patients prefer same-day misoprostol.
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA. Alisa_Goldberg@pplm.org
authors.forename: Alisa B
authors.initials: AB
authors.lastname: Goldberg
authors.forename: Eleanor A
authors.initials: EA
authors.lastname: Drey
authors.forename: Amy K
authors.initials: AK
authors.lastname: Whitaker
authors.forename: Mi-Suk
authors.initials: MS
authors.lastname: Kang
authors.forename: Karen R
authors.initials: KR
authors.lastname: Meckstroth
authors.forename: Philip D
authors.initials: PD
authors.lastname: Darney
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000032:Abortion, Therapeutic / Q000379:methods*; D000293:Adolescent; D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects* / Q000502:physiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007795:Laminaria; D016595:Misoprostol / Q000008:administration & dosage*; D010146:Pain; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol