Adjunctive Agents for Cervical Preparation in Second Trimester Surgical Abortion

Abstract

Late second trimester dilation and evacuation is a challenging subset of surgical abortion. Among the reasons for this is the degree of cervical dilation required to safely extricate fetal parts. Cervical dilation is traditionally achieved by placing multiple sets of osmotic dilators over two or more days prior to the evacuation procedure; however, there is interest in shortening cervical preparation time. The use of adjuvant mifepristone and misoprostol in conjunction with osmotic dilators has been studied for this purpose, and their use demonstrates that adequate cervical dilation can be achieved in less time than with dilators alone. We present a review of the current evidence surrounding adjunctive agents for cervical preparation, and contend that for women presenting for surgical abortion care above 19 weeks gestation, the use of adjunctive mifepristone and/or misoprostol should be strongly considered along with osmotic dilator insertion when cervical preparation in less than 24 h is needed.

The Impact of the COVID-19 Pandemic on the Care of Women Experiencing Abortion in a University Hospital in Brazil

“…14 Preparing the cervix prior to the procedure reduces this risk to less than 1% of cases. 15 Compared with manual dilation alone, it improves cervical dilation, shortens procedure times and decreases the risk of complications intraoperatively, such as cervical laceration and uterine perforation. 14 This study had some limitations.…”

“…The hospital follows the laws of Brazil regarding the legal termination of pregnancy, in which abortion is allowed only in cases of risk of maternal death, sexual violence, and fetal anencephaly. [7][8][9][10][11][12][13][14][15][16][17][18][19] The sentinel centers of the MUSA network regularly provide information on maternal morbidity in early pregnancy loss, termination methods for uterine evacuations, incidence of complications related to pregnancy termination, incidence of preoperative antibiotic use and prescription of contraception before hospital discharge. Through SIP, it is possible to carry out epidemiological monitoring and comparisons between different sentinel centers over time.…”

“…The hospital follows the laws of Brazil regarding the legal termination of pregnancy, in which abortion is allowed only in cases of risk of maternal death, sexual violence, and fetal anencephaly. 7 8 9 10 11 12 13 14 15 16 17 18 19 …”

Efficacy of vaginal isosorbide mononitrate with misoprostol versus oral mifepristone and misoprostol in induction of second trimester abortions: An RCT at a tertiary hospital

“…1million abortions performed are safe, as a result of comprehensive abortion care services provided by skilled service providers, but the maternal morbidity and mortality are due to unsafe abortions and delayed approach by clients for abortions. Various techniques such as surgical and medical methods for induction of abortions are currently used, among which medical abortions are popular and appear to be safe, and efficient [1][2][3][4][5][6] . Failure to abort with medical method necessitates search for alternate drugs and methods.…”