Cervical preparation for surgical abortion
Should be considered in all cases. It is particularly beneficial for the following patients with risk factors for cervical injury or uterine perforation:
- adolescents aged ≤17 years
- advanced gestational age (particularly among multipara)
- cervical anomalies or previous surgery
- when a less experienced surgeon is operating
The current WHO recommendation is that cervical preparation may be considered at any gestational age, but is recommended at 12-14 weeks of gestation.
Methods of cervical ripening include:
- pharmacological agents (recommended for up to 14 weeks of gestation):
- misoprostol 400 micrograms administered vaginally 3 hours prior to surgery or sublingually 2-3 hours prior to surgery
- vaginal misoprostol can be administered either by the woman herself or by a clinician
- osmotic dilators:
- after 14 weeks of gestation, osmotic dilators provide superior dilatation to medical methods resulting in greater reduction in procedure time in the early second trimester
- misoprostol is an acceptable alternative up to 18 weeks of gestation
- two types are available
- laminaria - made of compressed seaweed
- dilapan-S - made of polyacrylate based hydrogel
References:
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