Randomized trial of one versus two days of laminaria treatment prior to late midtrimester abortion by uterine evacuation: A pilot study

Abstract

Cervical dilatation prior to midtrimester abortion by surgical evacuation has been accomplished rapidly with metal dilators, or gradually with expanding laminaria tents, either as a single set left in place overnight or as multiple sets of laminaria replaced every few hours over a 40-hour period. In the effort to determine the benefit of an additional day of use of laminaria, 60 volunteer women who requested abortion at 17-19 weeks were randomly assigned to either of 2 experimental groups. Group A received 1 set of 3-7 small or medium laminaria Japonicum tents, and the abortions were performed the next morning, 18-22 hours later. Group B returned on the 2nd day for removal of the 1st set of laminaria tents and insertion of a 2nd set of 7-19 tents. Their abortions were performed on the 3rd day, 44-48 hours later. The cervical canal was calibrated with Hegar dilators prior to placement of laminaria tents, immediately prior to the abortion, and 2 weeks after the abortion. Pain from use of the laminaria tents was quantified on a 5-point scale. Mean age was 21.1 +or- 5.1 years in Group A and 22.6 +or- 5.6 years in Group B. Group A contained more primigravid women (15) than did Group B (6). Considerable cervical dilatation was accomplished by the laminaria treatment in both groups. Greater posttreatment dilatation and a greater difference between pretreatment and posttreatment measurements were accomplished by the 2-day regimen used with Group B. Equivalent posttreatment dilatations and dilatation differences were observed for nulliparous and parous women. Group B patients were more likely to report pain during laminarian treatment than were Group A patients. The surgeon experienced problems in extracting the fetal calvaria in 6 Group A patients and in only 2 Group B patients, but these frequencies were not statistically separable. Operating time and measured loss of blood were not different for the 2 groups, except for those patients in each group aborted after 18 weeks. Postabortal cervical measurements showed recovery of the cervix to small diameters, suggesting that gradual dilatation with laminaria tents to wide diameters is completely reversible, in contrast to dilatation accomplished forcibly with metal dilators.