To compare the abortifacient efficacy of vaginal
prostaglandin (PG) E2
suppositories with and without pretreatment with intracervical
PGE2 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
PGE2 vaginal suppositories alone to induce abortion, 72 had Laminaria placed 24 hours before vaginal
PGE2, and 62 were given intracervical 0.5 mg
PGE2 gel plus Laminaria 24 hours before vaginal
PGE2. 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 PGE2-only women (mean +/- standard deviation 689+/-319 minutes) compared with that of those receiving
PGE2 plus Laminaria (487+/-321 minutes) and
PGE2 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 PGE2-only group required more
suppositories (median three, range 1-8) compared with
PGE2 plus Laminaria (median 3, range 1-3) and
PGE2 plus Laminaria plus gel (median 2.5, range 1-9; P = .001). Patients in the
PGE2 plus Laminaria plus gel group reported more
pain associated with placement (median
pain score 4, range 0-10) compared with
PGE2 plus Laminaria (median 2, range 0-9; P = .003). There was a lower incidence of febrile episodes in the PGE2-only group (29%) compared with
PGE2 plus Laminaria (68%) and
PGE2 plus Laminaria plus gel (54%, P = .002).
CONCLUSION: Placement of Laminaria japonica 24 hours before
PGE2 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
PGE2 gel increased
pain associated with Laminaria placement and did not improve the efficacy of the procedure.