title: Buccal misoprostol plus laminaria for cervical preparation before dilation and evacuation at 21-23 weeks of gestation: a randomized controlled trial.
abstract: OBJECTIVE
  To describe the effectiveness of buccal misoprostol as an adjunct to laminaria for cervical ripening before later second-trimester abortion by dilation and evacuation (D&E).
  
  
  METHODS
  A randomized, double-blinded, placebo-controlled trial of 196 women undergoing D&E between 21 and 23 weeks of gestation. Subjects had overnight laminaria and 400 mcg buccal misoprostol or placebo 3-4 h before the abortion. We used logarithmic transformation of the primary outcome--D&E procedure duration--to achieve a normal distribution.
  
  
  RESULTS
  Mean D&E duration was 1.7 min shorter with misoprostol (p=.02). The median duration was 9.7 versus 10.4 min in the misoprostol and placebo groups, respectively (p=.09). Cervical dilation was slightly greater with misoprostol (median 75 mm vs. 73 mm, p=.04); however, physicians did not find the misoprostol D&Es easier to complete. Half of subjects reported severe pain after misoprostol vs. 11% with placebo (p<.001).
  
  
  CONCLUSIONS
  Adjuvant buccal misoprostol results in slightly shorter D&Es at the cost of more side effects.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA.
authors.forename: Eleanor A
authors.initials: EA
authors.lastname: Drey
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA.
authors.forename: Lyndsey S
authors.initials: LS
authors.lastname: Benson
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA.
authors.forename: Abby
authors.initials: A
authors.lastname: Sokoloff
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA.
authors.forename: Jody E
authors.initials: JE
authors.lastname: Steinauer
authors.affiliation: Department of Obstetrics and Gynecology, University of Montreal, Montréal, Québec, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Roy
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA. Electronic address: jacksonr@obgyn.ucsf.edu.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Jackson
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000009:adverse effects*; D000028:Abortion, Induced; D000284:Administration, Oral; D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007795:Laminaria; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Cervical ripening; Induced abortion; Misoprostol; Pain; Second trimester pregnancy