Laminaria versus extra-amniotic saline solution infusion for cervical ripening in second-trimester labor inductions

Objective: The aim of this study was to determine which cervical ripening method, laminaria placement or extra-amniotic saline solution infusion, was associated with the shorter interval from induction to delivery in the second trimester. Study Design: Women admitted for indicated second-trimester labor induction with an unfavorable cervix were randomly assigned to receive either intracervical placement of laminaria (n = 25) or extra-amniotic saline solution infusion (n = 25) with concurrent concentrated oxytocin and vaginally administered prostaglandin E2 (10 mg every 6 hours). Treatment success was defined as an interval from induction to delivery of ≤24 hours. Results: Maternal age, race, parity, gestational age, and initial cervical dilatation were similar between the groups. Indications for uterine evacuation were also similar and included fetal death (n = 7), aneuploidy (n = 20), fetal structural anomaly (n = 18), and maternal indications (n = 4). There was no difference in the mean intervals from induction to delivery (laminaria, 16 ± 8 hours, vs extra-amniotic saline solution infusion, 17 ± 10 hours) or the number of treatment successes (laminaria, N = 23, vs extra-amniotic saline solution infusion, N = 21). Retained placenta, live birth, and hemorrhage occurred with similar frequencies in the two groups. Conclusion: Relative to laminaria, extra-amniotic saline solution infusion did not shorten the induction-to-delivery interval in women undergoing indicated second-trimester labor induction with concentrated oxytocin and low-dose vaginally administered prostaglandin E2. (Am J Obstet Gynecol 2001;184:1145-8.)