Scientific Paper Abstracts Originally Presented at the National Abortion Federation's Annual Meeting; April 23, 2007; Boston, Massachusetts

In This Article

Serious Adverse Events Associated with Use of Misoprostol for Cervical Ripening in Early Second-Trimester Abortions (12-16 Weeks)

Mary Gatter, MD; Deb Nucatola, MD; Vallorie Saulsberry, MD, MPH

Introduction and Purpose/Objective(s): Our objective was to report on our experience with serious adverse events, particularly perforations, in a series of more than 6,000 cases of early second trimester abortions (12W0D to 16W0D) using 90 minutes of pre-op cervical preperation with 400 mcs of vaginal or buccal misoprostol. While there are a number of studies looking at misoprostol for cervical preperation in the first trimester, there are fewer studies examining outcomes for this technique in the early second trimester, and one of these recent studies suggested that misoprostol preperation might be associated with a higher perforation rate than tradional laminaria preperation. The authors of that study acknowledged that a larger group of patients (>2,911) would be needed to address this issue.

Data-Collection Methods: We collected data on how many early second trimester abortions were perfomed at our clinics between 4/1/01 and 12/31/06. We also collected data on how many serious adverse events were reported for this group. We then performed a literature search to determine from historical data what the benchmark perforation rate was for abortions performed at this gestational age.

Summary of Results: There were four serious adverse events, including three perforations and one placenta accreta, during the time frame in question. There were about 6,620 abortions performed. The perforation rate for our clinic was thus 3/6,620 or 0.45/1,000. The historically reported perforation rate for this gestational age was 0.8-7/1,000.

Conclusions: Cervical preparation with misoprostol in the early second trimester is not associated with a higher rate of perforations than has been reported historically for this procedure.


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