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

• Published in: Contraception (Stoneham) Vol. 73; no. 4; pp. 420 - 430
• Main Authors: Patel, Ashlesha, Talmont, Elizabeth, Morfesis, Johanna, Pelta, Murray, Gatter, Mary, Momtaz, Michael R., Piotrowski, Harry, Cullins, Vanessa
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2006; Elsevier Science
• Subjects: Abortifacient Agents, Nonsteroidal; Abortion; Abortion, Induced - adverse effects; Abortion, Induced - methods; Adequacy; Adolescent; Adult; Biological and medical sciences; Birth control; Buccal misoprostol; Cervical preparation; Cheek; Dilatation and Curettage; Female; Genital system. Reproduction; Gynecology. Andrology. Obstetrics; Humans; Induced abortion. Therapeutic abortion; Laminaria; Medical sciences; Misoprostol - administration & dosage; Misoprostol - adverse effects; Pharmacology. Drug treatments; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Safety; Second-trimester termination; Second-trimester termination; Cervical preparation; Buccal misoprostol; Safety; Adequacy; Abortion; Second trimester; Human; Toxicity; Induced abortion; Uterine cervix; Route of administration; Misoprostol; Pregnancy; Oral cavity; Local administration; Abortifacient; Preparation; Female; Prostaglandin derivatives
• ISSN: 0010-7824; 1879-0518
• DOI: 10.1016/j.contraception.2005.10.004

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. 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. 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. 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.