Second-trimester surgical abortion practices: a survey of National Abortion Federation members

Moderate intravenous sedation for first trimester surgical abortion: a comparison of adverse outcomes between obese and normal-weight women

“…Pain management options for surgical abortion include local anesthesia, oral, moderate, or deep sedation, and general anesthesia [6,7]. While deep sedation and general anesthesia provide the greatest analgesia, with these options patients are not easily arousable, sometimes require airway support and require monitoring by anesthesia professionals, limiting their availability in the outpatient setting [8].…”

“…With moderate intravenous (IV) sedation patients continue to respond purposefully to verbal or tactile stimulation and have better pain control and satisfaction compared to local anesthesia alone or in combination with oral sedation. Moderate IV sedation can be administered by a wider array of health care professionals and is more commonly available in the outpatient setting, with 40%-100% of first trimester patients receiving IV sedation [6][7][8][9][10][11][12][13].…”

Preoperative effects of mifepristone for dilation and evacuation after 19 weeks of gestation: a randomised controlled trial

“…4 Osmotic dilators or misoprostol, or a combination, are the most common methods for cervical preparation utilised in the USA. 4,5 Osmotic dilators, Dilapan-S and Laminaria, are cervical dilators that expand to a maximum diameter over 4-6 and 18-24 hours, respectively, to soften and dilate https://clinicaltrials.gov/ct2/show/NCT01862991 the cervix prior to D&E. 6,7 The use of osmotic dilators requires the woman to have an outpatient procedure in the day(s) prior to the day of the D&E. 4 Prior to D&E, misoprostol aids in cervical softening and decreases the force required for mechanical cervical dilation. 8 Studies of mifepristone for medical abortion in the second trimester, showing a 40-50% reduction in abortion times, 9 influenced research on cervical preparation for second trimester surgical abortion and increased the use of mifepristone for cervical preparation prior to D&E. [10][11][12][13][14][15] Mifepristone as an adjunct to osmotic dilators decreases the number of osmotic dilators needed after 19 weeks.…”

Issues in second trimester induced abortion (medical/surgical methods)

“…What raised their concern was the ageing of skilled practitioners, which may affect the future availability of second trimester abortion. 75 If the surgical expertise of D&E is available, both surgical and medical methods should be offered to the women who request second trimester termination of pregnancy and let them make their own choice based on the information provided and their acceptance. However, if the surgical expertise for D&E is not available, medical treatment should provide a safe option in case of second trimester abortion.…”