Alternatives in midtrimester abortion induction.

To develop objective criteria for the individualization of patient management, the results of a series of investigations of 1764 midtrimester pregnancy terminations are examined. These include intraamniotic instillation of hypertonic saline or prostaglandin F2 alpha, intramuscular 15(S)15-methyl prostaglandin F2 alpha, and intravaginal prostaglandin E2. Laminaria and intravenous oxytocin augmentation have also been used. The relative advantages and disadvantages of these techniques are evaluated in terms of safety, efficacy, and acceptability. The effects of parity and length of gestation are considered. Before 20 weeks' gestation, vaginal prostaglandin E2 is believed superior to the other techniques by most criteria, and intraamniotic saline is the authors' method of choice in amore advanced pregnancies.