Cervical preparation for first trimester surgical abortion

Abstract

Background Preparing the cervix prior to surgical abortion is intended to make the procedure both easier and safer. Options for cervical preparation include osmotic dilators and pharmacologic agents. Many formulations and regimens are available, and recommendations from professional organizations vary for the use of preparatory techniques in women of different ages, parity or gestational age of the pregnancy. Objectives To determine whether cervical preparation is necessary in the first trimester, and if so, which preparatory agent is preferred. Search methods We searched Cochrane, Popline, Embase, Medline and Lilacs databases for randomised controlled trials investigating the use of cervical preparatory techniques prior to first trimester surgical abortion. In addition, we hand-searched key references and contacted authors to locate unpublished studies or studies not identified in the database searches. Selection criteria Randomised controlled trials investigating any pharmacologic or mechanical method of cervical preparation, with the exception of nitric oxide donors (the subject of another Cochrane review), administered prior to first trimester surgical abortion were included. Outcome measures must have included the amount of cervical dilation achieved, the procedure duration or difficulty, side-effects, patient satisfaction or adverse events to be included in this review. Data collection and analysis Trials under consideration were evaluated by considering whether inclusion criteria were met as well as methodologic quality. Fiftyone studies were included, resulting in 24 different cervical preparation comparisons. Results are reported as odds ratios (OR) for dichotomous outcomes and weighted mean differences for continuous data.

Cervical Priming and Scar Rupture

“…The risk factors for major complications like uterine perforation or cervical laceration are increasing gestational age, operator inexperience, and uterine anomalies. Cervical priming results in easier mechanical dilatation along with reduction of procedure time, blood loss, and possibly the incidence of complications [3].…”

“…Hence, routine cervical preparation is not recommended. It may be considered for women at increased risk of complications due to patient factors and those in the late first trimester, though the exact gestational age at which there are clear benefits is yet unknown [3]. Counseling of the woman and informed consent are important.…”

Uterine cervix dilatation based on new insights of embryology - method description

“…Optimally, short dilatation time should be achieved: it was shown that osmotic dilatation next to Misoprostol were the most effective methods of cervical dilatation but long time is needed [17]. The new device allows to achieve the same results but in a shorter time.…”

Time to repeal outdated abortion laws in New South Wales and Queensland

“…o Nausea, vomiting diarrhoea 23,33 o Headache • 400 micrograms 51 inserted into the posterior fornix of the vagina OR 2-3 hours prior to surgery 2,13,51…”