Cervical dilation before first-trimester surgical abortion (< 14 weeks' gestation)

Abstract

First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction abortion is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester include increasing gestational age and provider inexperience. Cervical priming before first-trimester surgical abortion has been studied using osmotic dilators and pharmacologic agents, most commonly misoprostol. Extensive data demonstrate that a variety of agents are safe and effective at causing preoperative cervical softening and dilation; however, given the small absolute risk of complications, the benefit of routine use of misoprostol or osmotic dilators in first-trimester surgical abortion is unclear. Although cervical priming results in reduced abortion time and improved provider ease, it requires a delay of at least 1 to 3 h and may confer side effects. The Society of Family Planning does not recommend routine cervical priming for first-trimester suction abortion but recommends limiting consideration of cervical priming for women at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be challenging.

Single versus multiple cervical dilation by osmotic dilator before induction of labor for second‐trimester abortion

“…This represents delivery time since gemeprost is administered every 3 h. The area of lamicel before expansion was calculated by following formula (S: 1.5 × 1.5 × 3.14 = 7.065 mm 2 , L: 2.5 × 2.5 × 3.14 = 19.625 mm 2 ). In general, the osmotic dilator expands four times the original size thereby, S: area × 4 = 28.26, L: area × 4 = 78.5.…”

Tratamiento médico del aborto espontáneo del primer trimestre

“…La Sociedad de Planificación Familiar recomienda que se realice maduración cervical en las pacientes al final del primer trimestre (12-14 semanas de gestación), adolescentes, y en pacientes en las que se prevea que la dilatación cervical vaya a ser dificultosa, ya sea por factores de la mujer, o por inexperiencia del cirujano 96 .…”

“…Distintos estudios han demostrado que la dosis óptima en términos de efectividad-efectos secundarios es de 400 µg 97 . Se ha evaluado la vía de administración oral, vaginal y sublingual, siendo regímenes efectivos 400 µ g de misoprostol vaginal administrados 3-4 horas antes del procedimiento quirúrgico evacuador, 400 µg oral 8-12 horas antes, ó 400 µg sublingual 2-4 horas antes 96 .…”

“…No existe una clara evidencia para establecer que el misoprostol reduzca el dolor durante el procedimiento quirúrgico comparado con placebo 96 .…”

Misoprostol 1 to 3 h preprocedure vs. overnight osmotic dilators prior to early second-trimester surgical abortion

“…Additional advantages include patient acceptability of oral or buccal medications and decreased cost [9]. Several studies demonstrate increased dilation, greater ease of dilation and shorter procedure time when using 400 mcg of misoprostol administered buccally or vaginally 1-2 h prior to first-trimester surgical abortion [10,11]. However, data regarding the use of misoprostol alone prior to second-trimester surgical abortion are less clear.…”