A Randomized Trial of Laminaria Tents Versus Vaginal Misoprostol for Cervical Ripening in First Trimester Surgical Abortion

Burnett, Margaret; Corbett, Caroline; Gertenstein, Robyn J.

doi:10.1016/s1701-2163(16)30170-0

Cited by 18 publications

(15 citation statements)

References 12 publications

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“…Statistically, pain was not modified by premedication, parity, or gestational age. Two randomized trials have compared Laminaria to misoprostol for maternal satisfaction, but in the context of elective abortions [6,7] . In one, the patients preferred the misoprostol method, while in the other, less than 10% of the women in each group were dissatisfied with their method of dilatation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Induction-to-Delivery Interval in Terminations of Pregnancy with or without Dilapan-S®

Vincienne¹,

Anselem²,

Cordier

et al. 2017

Fetal Diagn Ther

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Objective: In France, terminations of pregnancy (TOP) for medical reasons beyond the second trimester use mifepristone and misoprostol. We sought to determine the effectiveness of Dilapan-S®, an osmotic cervical dilator, in shortening the induction-to-delivery interval (IDI). Materials and Methods: This retrospective study of TOP in 2010-2012 compared the results from 2 hospitals with different TOP protocols starting at 16 weeks' gestation, one (164 women) with and one (106) without Dilapan-S®. The principal endpoint was the IDI. Results were analyzed according to 2 definitions of induction onset: definition 1, first dose of misoprostol in both centers, or definition 2, dilator placement if used, and otherwise first dose of misoprostol. Results: With definition 1, the IDI was shorter with dilators (5 h 48 min vs. 10 h 18 min, p < 0.001); the rates of uterine evacuation within 12 and 24 h were higher (94.5 and 100 vs. 68.9 and 91.5%, p < 0.001), and the time between first misoprostol dose and amniotomy was shorter (0 h 47 min vs. 4 h 30 min, p < 0.001). Under definition 2, the IDI was longer with dilators (18 h 24 min vs. 10 h 18 min, p < 0.001), but the rate of evacuation within 24 h did not differ significantly. Conclusion: Dilapan-S® acts on cervical ripening and dilatation, thereby allowing early amniotomy. Assessing potential side effects and women's satisfaction requires prospective trials.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Induction-to-Delivery Interval in Terminations of Pregnancy with or without Dilapan-S®

Vincienne¹,

Anselem²,

Cordier

et al. 2017

Fetal Diagn Ther

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“…The risk for PT birth was not higher in subgroup analyses; however, only five studies reported outcomes based on the method of I‐TOP. With recent changes in the use of medications (misoprostol and mifepristone), 38 laminaria tents 77 etc; it would be important to assess outcomes in subsequent pregnancies as the element of cervical trauma can be minimised with these techniques. Studies have not reported size of dilators used for I‐TOP to analyse the effect of cervical trauma related to size of dilators.…”

Section: Discussionmentioning

confidence: 99%

Induced termination of pregnancy and low birthweight and preterm birth: a systematic review and meta‐analyses

Shah

Zao

2009

BJOG

131

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Background History of induced termination of pregnancy (I‐TOP) is suggested as a precursor for infant being born low birthweight (LBW), preterm (PT) or small for gestational age (SGA). Infection, mechanical trauma to the cervix leading to cervical incompetence and scarred tissue following curettage are suspected mechanisms. Objective To systematically review the risk of an infant being born LBW/PT/SGA among women with history of I‐TOP. Search strategy Medline, Embase, CINAHL and bibliographies of identified articles were searched for English language studies. Selection criteria Studies reporting birth outcomes to mothers with or without history of induced abortion were included. Data collection and analyses Two reviewers independently collected data and assessed the quality of the studies for biases in sample selection, exposure assessment, confounder adjustment, analytical, outcome assessments and attrition. Meta‐analyses were performed using random effect model and odds ratio (OR), weighted mean difference and 95% confidence interval (CI) were calculated. Main results Thirty‐seven studies of low–moderate risk of bias were included. A history of one I‐TOP was associated with increased unadjusted odds of LBW (OR 1.35, 95% CI 1.20–1.52) and PT (OR 1.36, 95% CI 1.24–1.50), but not SGA (OR 0.87, 95% CI 0.69–1.09). A history of more than one I‐TOP was associated with LBW (OR 1.72, 95% CI 1.45–2.04) and PT (OR 1.93, 95% CI 1.28–2.71). Meta‐analyses of adjusted risk estimates confirmed these findings. Conclusions A previous I‐TOP is associated with a significantly increased risk of LBW and PT but not SGA. The risk increased as the number of I‐TOP increased.

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“…Other studies of 400-mcg vaginal misoprostol have shown that no effect is seen 1 h after use and that the peak effect is achieved between 3 and 4 h after use [110,143,144]. No additional dilation is gained from administering vaginal misoprostol more than 4 h preoperatively [102,145]. Intervals of more than 4 h only increase the frequency of bleeding and passage of products of conception prior to scheduled curettage [145].…”

Section: Vaginal Administrationmentioning

confidence: 99%

“…No additional dilation is gained from administering vaginal misoprostol more than 4 h preoperatively [102,145]. Intervals of more than 4 h only increase the frequency of bleeding and passage of products of conception prior to scheduled curettage [145]. Thus, 400 mcg of vaginal misoprostol given 3 to 4 h before the procedure appears to be the optimal regimen for achieving adequate dilation.…”

Section: Vaginal Administrationmentioning

confidence: 99%

Cervical dilation before first-trimester surgical abortion (< 14 weeks' gestation)

Allen

Goldberg

2016

Contraception

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First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction abortion is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester include increasing gestational age and provider inexperience. Cervical priming before first-trimester surgical abortion has been studied using osmotic dilators and pharmacologic agents, most commonly misoprostol. Extensive data demonstrate that a variety of agents are safe and effective at causing preoperative cervical softening and dilation; however, given the small absolute risk of complications, the benefit of routine use of misoprostol or osmotic dilators in first-trimester surgical abortion is unclear. Although cervical priming results in reduced abortion time and improved provider ease, it requires a delay of at least 1 to 3 h and may confer side effects. The Society of Family Planning does not recommend routine cervical priming for first-trimester suction abortion but recommends limiting consideration of cervical priming for women at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be challenging.

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A Randomized Trial of Laminaria Tents Versus Vaginal Misoprostol for Cervical Ripening in First Trimester Surgical Abortion

Cited by 18 publications

References 12 publications

Comparison of the Induction-to-Delivery Interval in Terminations of Pregnancy with or without Dilapan-S®

Comparison of the Induction-to-Delivery Interval in Terminations of Pregnancy with or without Dilapan-S®

Induced termination of pregnancy and low birthweight and preterm birth: a systematic review and meta‐analyses

Cervical dilation before first-trimester surgical abortion (< 14 weeks' gestation)

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