Laminaria augmentation of intra-amniotic PGF2 for midtrimester pregnancy termination

Abstract

In our hands, intra-amniotic PGF2alpha 40 mg for midtrimester pregnancy termination had a mean infusion to abortion interval of 29.4 hr. However, pretreatment of 230 patients with laminaria tents inserted 14-18 hr before PGF2alpha infusion resulted in a dramatically reduced time to abortion (14.3 hr mean) with a low incidence of gastrointestinal and other side effects. Laminaria tents inserted at the same time as PGF2alpha infusion in 26 patients also resulted in reduced time to abortion (18.6 hr mean). In the laminaria pretreated group, the infusion to abortion interval was indirectly related to the number of laminaria inserted and not to the nulliparous or parous state. Although we have made significant strides in shortening the abortion interval in the hospital, retained placentae and blood loss persist as problems related to the use of prostaglandin for abortion.

PIP: A pilot study conducted by the authors in a group of 11 patients pretreated with intracervical laminaria tents 14 to 18 hours before prostaglandin (PG) infusion resulted in an improvement of treatment to abortion interval (29.4 hours). The proportion of patients requiring second amniocentesis was also minimized, as was the probability of serious cervical trauma. The present study evaluates the use of laminaria with intraamniotic PGF2a as the method of choice for midtrimester abortion service. 243 pregnant women, including the 11 in the pilot study, 16-20 weeks from last menstrual period, requested abortion by laminaria pretreatment before PGF2a infusion. The patients were divided into 1) initial group (n=20) treated with PGF2a alone; 2) pretreatment group with laminaria before PGF2a (n=230); and 3) group treated with simultaneous laminaria and PGF2a (n=26). The pretreatment group had a mean infusion to abortion interval of 14.3 hours, with a low incidence of gastrointestinal and other side effects. The simultaneously treated group had a mean infusion to abortion interval of 18.6 hours. In the pretreated group, infusion to abortion interval was indirectly related to the number of laminaria inserted rather than nulliparity or parity of the women. Transient fetal survival is more frequent with prostaglandin than with hypertonic saline for abortion, and retained placenta and resultant blood loss remains a problem. Further research should be done to establish the safety of laminaria pretreatment and PGF2a for abortion.