Late midtrimester medical pregnancy terminations: three different procedures with prostaglandin F2 alpha and laminaria tents

Abstract

One hundred twenty eight women underwent midtrimester induced abortion with: 1) combined regimen of intramniotic prostaglandin (PG) F2a injection and intracervical laminaria tents (group A, 50 women), 2) intramniotic PGF2a injection only (group B, 51 women) and 3) laminaria tents followed by intracervical PGF2a tablets insertion (group C, 27 women). The mean induction-abortion time (+/- SE) was 24.9 +/- 1.7 hours for group A, 28.2 +/- 2.2 hours for group B (p greater than 0.05) and 42.1 +/- 3.4 hours for group C, significantly longer than goup A and B (p less than 0.001 and p less than 0.01 respectively). In 48 hours 98% of the patients of group A, 90% of group B (p less than 0.05) and 59% of group C (p less than 0.001) completed the abortion procedure. Parous women of group A and B presented similar induction - abortion time, while in nulliparous the use of laminaria shortened the abortion procedure significantly (p less than 0.05). The complications rate was low. In conclusion, the intracervical PGF2a insertion is a simple but very slow abortion procedure with high failure rates. The intramniotic PGF2a injection is a successful method for late midtrimester medical pregnancy termination and the concurrent use of laminaria tents shortens the abortion procedure, particularly in nulliparous, reduces the number of prostaglandins' reinjections and increases the incidence of successful abortion within 48 hours.

PIP: 128 women underwent midtrimester induced abortion with the following: 1) a combined regimen of intraamniotic prostaglandin F2alpha (PGF2alpha) injection and intracervical laminaria tents (group A, 50 women); 2) intraamniotic PGF2alpha injection only (group B, 51 women); and 3) laminaria tents followed by intracervical PGF2alpha tablets insertion (group C, 27 women). The mean induction-abortion time (+or -SE) was 23.9 +or-1.7 hours for group A, 28.2 +or-2.2 hours for group B (p0.05), and 42.1 +or-3.4 hours for group C, which was significantly longer than groups A or B (p0.001 and p0.01). In 48 hours, 98% of the patients in group A, 90% of group (p0.05), and 59% of group C (p0.001) completed the abortion procedure. Parous women in groups A and B presented similar induction-abortion time, while among nulliparous women, the use of laminaria shortened the abortion procedure significantly (p0.05). The complications rate was low. In conclusion, the intracervical PGF2alpha insertion is a simple but very slow abortion procedure with high failure rates. The intraamniotic PGF2alpha injection is a successful method for late midtrimester medical pregnancy termination and the concurrent use of laminaria tents shortens the abortion procedure, particularly in nulliparous women, reduces the number of PG reinjections, and increases the incidence of successful abortion within 48 hours.