ABSTRACT
Objective
Evaluate if same-day cervical preparation is associated with a clinically acceptable
complication rate compared with overnight osmotic dilators for dilation and evacuation
(D&E).
Study Design
This retrospective, noninferiority, cohort study compared complication rates for same-day
versus overnight cervical preparation with D&E between 14 and 16 weeks gestation.
Cervical preparation was achieved with misoprostol, osmotic dilators, or both. Our
primary outcome was the acute complication rate, defined as: hemorrhage (≥500 mL);
hospitalization or hospital transfer; transfusion; or unplanned procedure occurring
within 24 hours of the index procedure. Secondarily we evaluated nonmajor (re-aspiration,
suture repair of cervical laceration, uterine tamponade, or emergency department only
transfer) and major (transfusion, uterine artery embolization, abdominal surgery,
or hospital admission) complications separately. Inverse probability of treatment
weighting using the propensity score was used to perform an adjusted analysis, taking
into account age, ethnicity, clinic location, insurance, gestational age, gravidity,
and prior pregnancy outcomes.
Results
We analyzed 1,319 subjects (n = 864 same-day, n = 455 overnight). Same-day cervical
preparation patients were more likely to have Medicaid and a prior vaginal delivery.
In both unadjusted and adjusted analyses, acute complication rates for same-day were
noninferior to overnight preparation (unadjusted 0.93% vs 1.98%, difference of −1.05%,
CI: −2.48% to 0.38%; adjusted difference −0.50%, CI: −1.45 to 0.44%). Only one major
complication in the same-day group, a cervical laceration resulting in hemorrhage
requiring transfusion, occurred in the entire sample.
Conclusions
In this retrospective review, same-day cervical preparation was noninferior to overnight
preparation for D&E between 14 and 16 weeks gestation, both with low complication
rates.
Implications
For early second trimester dilation and evacuation, same-day cervical preparation
should be considered a safe alternative to overnight cervical preparation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Measures to prevent cervical injury during suction curettage abortion.Lancet. 1983; 1: 1182-1185
- Prevention of uterine perforation during curettage abortion.JAMA. 1984; 251: 2108-2111
- Cervical preparation for second-trimester surgical abortion prior to 20 weeks' gestation: SFP Guideline #2013-4.Contraception. 2014; 89: 75-84
- First-trimester surgical abortion practices: a survey of National Abortion Federation members.Contraception. 2009; 79: 385-392
MPIP I. Laminaria. 2012.
FEMA International BaJC I. Dilapan-S hygroscopic cervical dilator: international instructions for use. 2012. 2012.
- Buccal misoprostol compared with synthetic osmotic cervical dilator before surgical abortion: a randomized controlled trial.Obstetr Gynecol. 2013; 122: 57-63
- Complications of first-trimester abortion by vacuum aspiration after cervical preparation with and without misoprostol: a multicentre randomised trial.Lancet. 2012; 379: 1817-1824
- Misoprostol compared with laminaria before early second-trimester surgical abortion: a randomized trial.Obstetr Gynecol. 2005; 106: 234-241
- Same-day synthetic osmotic dilators compared with overnight laminaria before abortion at 14-18 weeks of gestation: a randomized controlled trial.Obstetr Gynecol. 2014; 123 (Pt 1): 271-278
- Incidence of emergency department visits and complications after abortion.Obstetr Gynecol. 2015; 125: 175-183
- Obesity as a risk factor for complications after second-trimester abortion by dilation and evacuation.Obstetr Gynecol. 2015; 126: 585-592
- Cervical preparation before dilation and evacuation using adjunctive misoprostol or mifepristone compared with overnight osmotic dilators alone: a randomized controlled trial.Obstet Gynecol. 2015; 126: 599-609
- Serious adverse events associated with the use of misoprostol alone for cervical preparation prior to early second trimester surgical abortion (12-16 weeks).Contraception. 2008; 78: 245-248
- A randomized trial of misoprostol versus laminaria before dilation and evacuation in South Africa.Contraception. 2014; 90: 234-241
Article Info
Publication History
Published online: October 11, 2022
Accepted:
September 14,
2022
Received in revised form:
September 13,
2022
Received:
January 10,
2022
Footnotes
Conflict of interest: No potential conflicts of interest. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of Planned Parenthood Federation of America, Inc.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
