A Randomized Trial of Laminaria Tents Versus Vaginal Misoprostol for Cervical Ripening in First Trimester Surgical Abortion

Objective: To compare the use of laminaria tents with misoprostol for cervical ripening prior to first trimester surgical abortion.Method: In a prospective, open-label, randomized trial, 70 women were assigned to have either insertion of a 3 mm intracervical laminaria tent or vaginal misoprostol 200 µg on the day prior to suction dilatation and curettage (D&C). Cervical dilatation and operating time were measured at the time of D&C; the surgeon subjectively rated the ease of dilatation. The women were interviewed just prior to the D&C with regard to pain, vaginal bleeding, and dilator preference.Results: Laminaria produced significantly (P < 0.001) greater pre-abortion dilatation of the cervix (34.8 Pratt ± 6.2) than did misoprostol (28.4 Pratt ± 5.8). There was no demonstrable difference in ease of dilatation or operating time. Women randomized to use of laminaria reported significantly more pain on insertion than did those who received misoprostol (P < 0.001). Conversely, misoprostol was associated with more vaginal bleeding (P < 0.01). Pain following insertion was similar in each group. Two patients aborted completely after misoprostol alone. Overall, the stated patient preference for cervical dilator was more likely to be misoprostol (P < 0.01).Conclusions: Laminaria tents are more effective cervical dilators than vaginal misoprostol when inserted the day prior to suction D&C. Vaginal misoprostol insertion is more comfortable, although it is associated with an increased risk of vaginal bleeding and may abort the pregnancy. Patient preference favours misoprostol. In patient-centred care, both laminaria and misoprostol are suitable options for cervical preparation prior to suction D&C.