Cervical preparation for surgical abortion from 20 to 24 weeks' gestation

Intrauterine lidocaine for pain control during laminaria insertion: a randomized controlled trial

“…Second trimester abortion by dilation and evacuation (D&E) requires greater cervical dilation than first trimester procedures; to improve safety the dilation is commonly done by placement of osmotic dilators such as laminaria one or two days before the D&E procedure [1][2][3]. Many women find laminaria placement painful if no anesthesia is used [4,5]; several studies have reported that the procedure may be associated with moderate to severe pain even when cervical or paracervical block is performed [6][7][8].…”

Adjunct mifepristone for cervical preparation prior to dilation and evacuation: a randomized trial

“…A survey of US abortion providers in [2006][2007] showed that 86% of providers used osmotic dilators and 74% use both osmotic dilators and misoprostol for preprocedure cervical preparation [8]. There is insufficient evidence to define the number of dilators or length of time required for cervical preparation for D&E, but after 19-20 weeks, expert opinion recommends at least 1 day of cervical preparation [4]; one or two sets of osmotic dilators placed 24-48 h prior to the procedure is common clinical practice [9]. Protocols requiring multiple-day preparation may be particularly burdensome for patients traveling to obtain an abortion, requiring more time off work and money for hotel accommodations, in addition to the discomfort of repeated outpatient procedures to place osmotic dilators.…”

“…Preprocedure cervical preparation, using a combination of osmotic dilators and pharmaceutical methods, is associated with a decreased risk of complications [4][5][6][7]. A survey of US abortion providers in [2006][2007] showed that 86% of providers used osmotic dilators and 74% use both osmotic dilators and misoprostol for preprocedure cervical preparation [8].…”

Cervical Preparation Before Dilation and Evacuation Using Adjunctive Misoprostol or Mifepristone Compared With Overnight Osmotic Dilators Alone

“…[6][7][8] The prostaglandin, misoprostol, is widely used with osmotic dilators before second-trimester dilation and evacuation, [9][10][11] yet limited data support this practice beyond 16 weeks of gestation. 12 One study gave adjuvant buccal misoprostol 90 minutes preoperatively and showed no benefit between 16-19 weeks of gestation but increased dilation at 19-21 weeks of gestation, suggesting a gestational effect. 13 The other study gave adjuvant buccal misoprostol 3 hours preoperatively and found no significant difference in dilation and evacuation procedure times at 21-23 weeks of gestation.…”