Adequacy and safety of buccal misoprostol for cervical preparation prior to termination of second-trimester pregnancy

Objective: The objective of this retrospective, descriptive study is to assess the adequacy and safety of buccal misoprostol with and without laminaria for cervical preparation prior to second-trimester abortion. Methods: We analyzed Planned Parenthood Federation of America data from 2218 elective dilation and evacuation (D&E) procedures conducted on women at 12 to 23 6/7 weeks of gestation from April 2002 to March 2003. Each woman received 400, 600 or 800 μg of buccal misoprostol with or without laminaria for preprocedural cervical preparation. Results: Of the patients, 62% received 400 μg, 32% received 600 μg and 6% received 800 μg of buccal misoprostol; 42.8% had laminaria inserted for phased cervical preparation. The adequacy of cervical dilation was 88.7%. The D&E procedure was completed during a single surgical procedure for 99.8%. The overall adverse event rate was 19.39 per 1000 women, with a rate of 4.51 per 1000 women for serious adverse events. Conclusions: This descriptive study suggests that use of buccal misoprostol with or without laminaria is effective and safe. If buccal misoprostol eliminates or reduces the need for phased, multiday laminaria 1-3 days prior to the surgical procedure, then its use may offer service advantages such as reduced number of clinic visits and fewer pelvic examinations per woman.