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

In This Article

Mifepristone Versus Laminaria: A Randomized Controlled Trial of Cervical Ripening in Midtrimester Induction

Beth A. Prairie, MD; Michele R. Lauria, MD, MS; Nathalie Kapp, MD, MPH; Todd MacKenzie, PhD; Emily R. Baker, MD; Karen E. George, MD

Introduction and Purpose/Objective(s): Both dilatation and evacuation (D&E) and induction of labor (IOL) are used for midtrimester termination at 15-22 weeks' gestation. Cervical ripening decreases the incidence of complications from both D&E and IOL. Several methods of cervical ripening have been evaluated in the second trimester. Cervical ripening prior to induction has no demonstrated efficacy in induction termination, but has been practiced widely. Our objective was to compare mifepristone with laminaria in second trimester termination of pregnancy.

Data-Collection Methods: This is a randomized controlled open label study of women undergoing second trimester induction of labor for fetal demise, aneuploidy, or anomalies at a single tertiary care center from January 2004-May 2006. Main outcome measures were induction to delivery time and pain with cervical ripening. Eligible women were asked to participate in this research study prior to admission. After completion of the consent process, they were randomly assigned using a computer-generated blocked randomization schedule and sequentially numbered opaque envelopes. Women randomized to the mifepristone group were administered a 200-mg mifepristone tablet at the time of their office visit approximately 24 hours prior to planned admission for labor induction. Women randomized to laminaria were scheduled for outpatient placement the day prior to induction. Labor was induced using 400 mcg of intravaginal misoprostol every 6 hours.

Summary of Results: Thirty-seven of 50 eligible women enrolled in the study, of whom 33 completed the study: 16 randomized to laminaria and 17 to mifepristone. Induction to delivery time was significantly shorter in the mifepristone arm (10 vs. 16 hours, p = 0.01). Pain with cervical ripening was also significantly less in the mifepristone group than in the laminaria group (median of 1 vs. 6 on an 11 point Visual Analog Scale, p < 0.001). Maternal age, parity, gestational age, fetal demise prior to induction, need for post-partum curettage, blood loss, pain during induction, delivery and at the time of discharge were not significantly different between the two groups.

Conclusions: Second trimester termination with mifepristone and misoprostol decreases the time to completed abortion when compared to laminaria and misoprostol, without an increase in side effects or serious complications. Patients report a less painful process than with laminaria and misoprostol. A single 200-mg dose of mifepristone followed by misoprostol for induction of labor 24 hours later is a safe, well-tolerated, and effective method of second trimester termination.

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