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Randomised trial of hypan versus gemeprost in cervical preparation prior to second trimester termination of pregnancy


 The findings of a preliminary study of women undergoing second-trimester dilatation and evacuation for pregnancy termination suggest that hypan produces better cervical preparation than the more commonly used prostaglandin gemeprost. All 50 subjects were between 15-20 weeks' gestation. The 25 women who were randomly assigned to the gemeprost group had a 1 mg vaginal pessary inserted in the posterior fornix 4-6 hours before abortion; an additional 1 mg pessary was inserted 2-4 hours before the procedure in nulliparous women. The 25 women in the hypan group had either a 3 x 55 mm dilator (15-17 weeks' gestation) or a 4 x 65 mm dilator (18-20 weeks' gestation) inserted in the cervix 24 hours pre-operatively. The mean pre-dilatation cervical diameter was significantly greater (p 0.0001) in the hypan group (14.5 mm) than the gemeprost group (8.7 mm). Also significantly greater (p 0.01) was the mean post-dilatation cervical diameter: 19.3 mm for hypan compared to 17.1 for gemeprost. Dilatation was rated as easy by 21 women in the hypan group compared to only 10 in the gemeprost group. In the hypan group, 24 women reported no pre-operative pain and 23 experienced no post-operative pain; in the gemeprost group, these numbers were 15 and 14, respectively. There were 4 cases of pre-operative bleeding among gemeprost acceptors but none in the hypan group. Finally, at the 6-week follow-up, 1 patient in the gemeprost group reported she had required evacuation of retained products of conception and 1 woman in the hypan group had been treated with antibiotics for a urinary tract infection. Although hypan, unlike gemeprost, requires insertion by a trained physician or nurse, its substantially lower cost, better cervical preparation, and lack of side effects justify its more widespread use.
