Adequacy and safety of buccal misoprostol for cervical preparation prior to termination of second-trimester pregnancy

Abstract 

Objective

The objective of this retrospective, descriptive study is to assess the adequacy and safety of buccal misoprostol with and without laminaria for cervical preparation prior to second-trimester abortion.

Methods

We analyzed Planned Parenthood Federation of America data from 2218 elective dilation and evacuation (D&E) procedures conducted on women at 12 to 23 6/7 weeks of gestation from April 2002 to March 2003. Each woman received 400, 600 or 800 μg of buccal misoprostol with or without laminaria for preprocedural cervical preparation.

Results

Of the patients, 62% received 400 μg, 32% received 600 μg and 6% received 800 μg of buccal misoprostol; 42.8% had laminaria inserted for phased cervical preparation. The adequacy of cervical dilation was 88.7%. The D&E procedure was completed during a single surgical procedure for 99.8%. The overall adverse event rate was 19.39 per 1000 women, with a rate of 4.51 per 1000 women for serious adverse events.

Conclusions

This descriptive study suggests that use of buccal misoprostol with or without laminaria is effective and safe. If buccal misoprostol eliminates or reduces the need for phased, multiday laminaria 1–3 days prior to the surgical procedure, then its use may offer service advantages such as reduced number of clinic visits and fewer pelvic examinations per woman.

Keywords: Buccal misoprostol, Cervical preparation, Second-trimester termination, Abortion, Safety, Adequacy