A randomized clinical trial of the addition of laminaria to misoprostol and hypertonic saline for second-trimester induction abortion

To compare the outcomes of second-trimester induction abortion with misoprostol and hypertonic saline, with and without use of laminaria. Fifty-eight women, between 17.5 and 22.5 weeks' gestation, were randomly assigned to receive or omit laminaria in conjunction with other procedures for induction abortion. All women received a fetocidal dose of 60 cc intra-amniotic hypertonic saline. If the woman was to receive laminaria, they were inserted next. This was followed by vaginal misoprostol 200 μg, which was repeated every 6 h. Women with laminaria inserted before misoprostol administration had longer intervals from start of misoprostol to delivery of the fetus (induction times) than women without laminaria. Induction time was 14.4 vs. 11.4 h, respectively (p=.04, Wilcoxon rank sum test). Total misoprostol use was higher in the laminaria group, 628 μg (95% CI, 516–738) vs. 496 μg (95% CI, 419–573) (p=.05). Total analgesic use was also higher in the laminaria group, 41 mg of morphine (95% CI, 32–50) vs. 26 mg of morphine (95% CI, 18–32) (p=.02). Laminaria use, in conjunction with misoprostol and hypertonic saline, significantly prolongs induction time and increases narcotic analgesia usage.