A Randomized Controlled Trial of Laminaria, Oral Misoprostol, and Vaginal Misoprostol Before Abortion

MacIsaac, Laura; Grossman, Daniel; Balistreri, Elizabeth; Darney, Philip D.

doi:10.1097/00006250-199905000-00026

Cited by 9 publications

(11 citation statements)

References 14 publications

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“…A 400-g vaginal dose, placed 3-4 hours before procedure, produces enough dilatation for most first-trimester procedures with minimal side effects and little expense. 22,23 Vacuum curettage, performed with a 6-mm flexible cannula and modified 60-mL syringe, has been used worldwide since the 1970s. Initially, manual vacuum aspiration was used only at 6 -7 menstrual weeks.…”

Section: Vacuum Curettagementioning

confidence: 99%

Methods for Induced Abortion

Stubblefield

Carr-Ellis

Borgatta

2004

Obstetrics & Gynecology

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We describe present methods for induced abortion used in the United States. The most common procedure is first-trimester vacuum curettage. Analgesia is usually provided with a paracervical block and is not completely effective. Pretreatment with nonsteroidal analgesics and conscious sedation augment analgesia but only to a modest extent. Cervical dilation is accomplished with conventional tapered dilators, hygroscopic dilators, or misoprostol. Manual vacuum curettage is as safe and effective as the electric uterine aspirator for procedures through 10 weeks of gestation. Common complications and their management are presented. Early abortion with mifepristone/misoprostol combinations is replacing some surgical abortions. Two mifepristone/misoprostol regimens are used. The rare serious complications of medical abortion are described. Twelve percent of abortions are performed in the second trimester, the majority of these by dilation and evacuation (D&E) after laminaria dilation of the cervix. Uterine evacuation is accomplished with heavy ovum forceps augmented by 14-16 mm vacuum cannula systems. Cervical injection of dilute vasopressin reduces blood loss. Operative ultrasonography is reported to reduce perforation risk of D&E. Dilation and evacuation procedures have evolved to include intact D&E and combination methods for more advanced gestations. Vaginal misoprostol is as effective as dinoprostone for second-trimester labor-induction abortion and appears to be replacing older methods. Mifepristone/misoprostol combinations appear more effective than misoprostol alone. Uterine rupture has been reported in women with uterine scars with misoprostol abortion in the second trimester. Fetal intracardiac injection to reduce multiple pregnancies or selectively abort an anomalous twin is accepted therapy. Outcomes for the remaining pregnancy have improved with experience.

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Section: Vacuum Curettagementioning

confidence: 99%

Methods for Induced Abortion

Stubblefield

Carr-Ellis

Borgatta

2004

Obstetrics & Gynecology

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“…Many women find laminaria placement painful if no anesthesia is used [4,5]; several studies have reported that the procedure may be associated with moderate to severe pain even when cervical or paracervical block is performed [6][7][8]. While multiple studies have evaluated various methods for controlling pain in abortion procedures [9], no studies to date have specifically evaluated different methods of pain control for laminaria insertion.…”

Section: Introductionmentioning

confidence: 99%

Intrauterine lidocaine for pain control during laminaria insertion: a randomized controlled trial

Mercier

Liberty

2014

Contraception

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“…Previously published literature is heterogeneous with regard to route, dosage and preprocedure duration of misoprostol for cervical preparation between 14 and 20 weeks. Existing literature describes using routes including vaginal and buccal doses ranging from 200 to 800 mcg, and durations of use between as little as 90 min to 3-4 h [9,[12][13][14][15][16]. Nucatola and colleagues' [18] case series of 6620 surgical abortions between 12 and 16 weeks performed after 90 min of cervical preparation with misoprostol (400 mcg via either vaginal or buccal administration) noted a 0.45/1000 uterine perforation rate, similar to baseline risk reported in the literature of 0.8-7/1000 uterine perforations/surgical second-trimester abortions.…”

Section: Discussionmentioning

confidence: 99%

“…However, data regarding the use of misoprostol alone prior to second-trimester surgical abortion are less clear. Existing studies vary regarding gestational age range, route of administration and duration of use with inconsistent results on overall procedure time and ease of dilation [12][13][14][15][16]. Despite conflicting data, in a 2001 survey of National Abortion Federation clinics, 40% of respondents reported routinely using misoprostol alone for cervical preparation at 16 weeks or less [17].…”

Section: Introductionmentioning

confidence: 99%