title: A randomized clinical trial of the addition of laminaria to misoprostol and hypertonic saline for second-trimester induction abortion.
abstract: OBJECTIVE
  To compare the outcomes of second-trimester induction abortion with misoprostol and hypertonic saline, with and without use of laminaria.
  
  
  METHODS
  Fifty-eight women, between 17.5 and 22.5 weeks' gestation, were randomly assigned to receive or omit laminaria in conjunction with other procedures for induction abortion. All women received a fetocidal dose of 60 cc intra-amniotic hypertonic saline. If the woman was to receive laminaria, they were inserted next. This was followed by vaginal misoprostol 200 mug, which was repeated every 6 h.
  
  
  RESULTS
  Women with laminaria inserted before misoprostol administration had longer intervals from start of misoprostol to delivery of the fetus (induction times) than women without laminaria. Induction time was 14.4 vs. 11.4 h, respectively (p=.04, Wilcoxon rank sum test). Total misoprostol use was higher in the laminaria group, 628 mug (95% CI, 516-738) vs. 496 mug (95% CI, 419-573) (p=.05). Total analgesic use was also higher in the laminaria group, 41 mg of morphine (95% CI, 32-50) vs. 26 mg of morphine (95% CI, 18-32) (p=.02).
  
  
  CONCLUSIONS
  Laminaria use, in conjunction with misoprostol and hypertonic saline, significantly prolongs induction time and increases narcotic analgesia usage.
authors.affiliation: Department of Obstetrics and Gynecology, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA. lynn.borgatta@bmc.org
authors.forename: Lynn
authors.initials: L
authors.lastname: Borgatta
authors.forename: Angela Y
authors.initials: AY
authors.lastname: Chen
authors.forename: Olivera
authors.initials: O
authors.lastname: Vragovic
authors.forename: Phillip G
authors.initials: PG
authors.lastname: Stubblefield
authors.forename: Christ-Ann
authors.initials: CA
authors.lastname: Magloire
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced; D000282:Administration, Intravaginal; D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D007795:Laminaria; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D013997:Time Factors
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol