| Cervical preparation for second-trimester surgical abortion prior to 20 weeks of gestation. | |
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MedLine Citation:
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PMID: 18061709 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Roughly 11% of induced abortions in the United States are performed after 14 weeks of gestation, most commonly by dilation and evacuation (D&E). For a D&E procedure, the cervix must be dilated sufficiently to allow passage of operative instruments and products of conception without injuring the uterus or cervical canal. Preoperative preparation of the cervix reduces the risk of cervical laceration and uterine perforation. The cervix may be prepared with osmotic dilators, prostaglandin analogues, or both. Osmotic dilators currently available in the United States include Dilapan-S, Lamicel, and laminaria. Laminaria tents are made from dehydrated seaweed and require 12-24 h to achieve greatest dilation. The synthetic products, Dilapan-S and Lamicel, achieve maximum effect within 6 h. Dilapan-S achieves greater dilation than the others and, thus, requires fewer dilators to be placed but may be more difficult to remove. For same day procedures, Dilapan-S and Lamicel are preferable to laminaria. A single set of one to several dilators is usually adequate for D&E before 20 weeks of gestation. Additional sets over 1-2 days may be needed in challenging cases. Misoprostol, a prostaglandin analogue, is sometimes used instead of osmotic dilators; however, the data to support such use are limited. Misoprostol is inferior to overnight dilation with laminaria for cervical priming prior to D&E. Misoprostol use as an adjunct to overnight osmotic dilation is only marginally beneficial for priming beyond 16 weeks and does not truly demonstrate any benefit before 19 weeks of gestation. Limited data demonstrate the safety of misoprostol prior to D&E in patients with a uterine scar. The Society of Family Planning recommends preoperative cervical preparation to decrease the risk of complications when performing a D&E prior to 20 weeks of gestation. The three currently available osmotic dilators (laminaria, Lamicel, and Dilapan-S) are safe and effective for this use. Since no single protocol has been found to be superior, clinical judgment is warranted when selecting a method of preoperative cervical preparation. |
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Authors:
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Michelle C Fox; Jennifer L Hayes; |
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Publication Detail:
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Type: Journal Article; Practice Guideline Date: 2007-11-09 |
Journal Detail:
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Title: Contraception Volume: 76 ISSN: 0010-7824 ISO Abbreviation: Contraception Publication Date: 2007 Dec |
Date Detail:
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Created Date: 2007-12-06 Completed Date: 2008-03-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0234361 Medline TA: Contraception Country: United States |
Other Details:
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Languages: eng Pagination: 486-95 Citation Subset: IM |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Abortion, Induced
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methods* Cervix Uteri / drug effects* Female Humans Labor Stage, First / drug effects* Laminaria Magnesium Sulfate / therapeutic use Misoprostol / therapeutic use Polymers / therapeutic use Polyvinyl Alcohol / therapeutic use Pregnancy Pregnancy Trimester, Second Vacuum Curettage / methods* |
| Chemical | |
Reg. No./Substance:
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0/Lamicel; 0/Polymers; 123535-69-3/dilapan; 59122-46-2/Misoprostol; 7487-88-9/Magnesium Sulfate; 9002-89-5/Polyvinyl Alcohol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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