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
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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.
