Clinical GuidelinesCervical dilation before first-trimester surgical abortion (<14 weeks' gestation)
Section snippets
Background
Induced abortion is one of the most common surgical procedures in the United States. In 2002, 1.3 million pregnancies were terminated, approximately 90% at less than 14 weeks' gestation [1]. First-trimester surgical abortion is a safe procedure with a mortality rate of 0.7 per 100,000 procedures performed under 13 weeks' gestation and a major complication rate of less than 1% [2], [3]. The rate of recognized uterine perforation during first-trimester surgical abortion ranges from 0.1 to 4 per
How much rigid dilation is needed to perform a suction abortion?
There is no consensus among providers regarding the desired width of dilation. Frequently, in early first-trimester procedures (<8 weeks), no dilation is required to insert the desired cannula, especially in multiparous women. In the past, when half-size Hegar dilators were preferred, providers dilated the cervix 0.5 to 2 mm less than the gestational age in weeks [12]. According to a recent survey of North American providers, approximately half report dilating the cervix to a diameter in
Level A: recommendations are based primarily on good and consistent scientific evidence
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Advancing gestational age and provider inexperience are risk factors for immediate complications during first-trimester surgical abortion.
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Adolescents are at higher risk for cervical injury than adult women.
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Cervical priming may protect against complications such as cervical injury and uterine perforation; however, the absolute risk of these complications, given an experienced provider, is quite low.
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Effective methods of cervical priming include osmotic dilators and misoprostol; the shortest time
Important questions to be answered
Further studies should evaluate whether routine cervical priming with misoprostol reduces the frequency of immediate complications during first-trimester suction aspiration. Given the rarity of such events and the dependency of these events on various factors (adolescence, parity, gestational age, prior cervical surgery and provider experience), an extremely large sample size would be required to detect a difference between misoprostol and placebo. The recently completed WHO trial [149] must
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Cervical priming before surgical abortion up to 13<sup>+6</sup> weeks’ gestation: a systematic review and metaanalyses for the National Institute for Health and Care Excellence—new clinical guidelines for England
2020, American Journal of Obstetrics and Gynecology MFMCitation Excerpt :It is unclear whether the benefits of its use outweigh its adverse effects and if its use should be restricted to particular groups. Therefore, there is variation in care and recommendations from national and international guidelines,1,2 although United Kingdom guidelines from 2011 state that “cervical preparation should be considered in all cases.”3 Cervical priming before surgical abortion was identified as being an important topic for review by stakeholders in the scoping phase of the development of the 2019 abortion care clinical guideline by the National Institute for Health and Care Excellence (NICE).
Comparative Efficacy of Vaginal Misoprostol vs Vaginal Dinoprostone Administered 3 Hours Prior to Copper T380A Intrauterine Device Insertion in Nulliparous Women: A Randomized Controlled Trial
2020, Journal of Pediatric and Adolescent GynecologyN<sup>o</sup> 360 - Avortement provoqué: avortement chirurgical et méthodes médicales au deuxième trimestre
2018, Journal of Obstetrics and Gynaecology CanadaNo. 360-Induced Abortion: Surgical Abortion and Second Trimester Medical Methods
2018, Journal of Obstetrics and Gynaecology CanadaA randomized double-blind controlled trial of two different doses of self-administered vaginal misoprostol for successful copper intrauterine device insertion
2017, Middle East Fertility Society Journal