Cervical preparation for second-trimester procedural abortion.
Journal
Current opinion in obstetrics & gynecology
ISSN: 1473-656X
Titre abrégé: Curr Opin Obstet Gynecol
Pays: England
ID NLM: 9007264
Informations de publication
Date de publication:
01 12 2023
01 12 2023
Historique:
medline:
3
11
2023
pubmed:
8
9
2023
entrez:
7
9
2023
Statut:
ppublish
Résumé
To review the evidence-informed options for cervical preparation prior to second-trimester dilation and evacuation (D&E). As abortion restrictions increase and the number of abortion clinics and providers decreases, pregnant people are facing more barriers to abortion access. Those in need are now often required to travel for second-trimester abortion care, only to be faced with additional restrictions, such as mandatory waiting periods. Cervical preparation is recommended prior to D&E and takes time for effect. Given the increasing time required to obtain an abortion, patients and providers may prefer same-day cervical preparation to decrease the total time required. Options for same-day cervical preparation include misoprostol alone with single or serial doses, and misoprostol combined with osmotic dilators or transcervical balloon (Foley catheter). Same-day preparation may require additional clinical space to accommodate people after initiation of cervical preparation to manage side-effects and timing of the abortion. Overnight options are also used and more frequently later in the second trimester. Overnight options include mifepristone, osmotic dilators, and transcervical balloon and are often combined with same-day misoprostol. Medication alone preparation is well tolerated and effective in the second trimester, with the addition of mechanical methods with advancing gestation. With many options and combinations being safe and effective, providers can be dynamic and alter approach with supply shortages, adjust to different clinical settings, consider patient medical and surgical factors, and accommodate provider and patient preferences. Multiple pharmacologic and mechanical options have been shown to be safe and effective for cervical preparation prior to D&E. Consideration for multiple factors should influence the method of cervical preparation and methods may vary by patient, provider and setting.
Identifiants
pubmed: 37678155
doi: 10.1097/GCO.0000000000000912
pii: 00001703-990000000-00092
doi:
Substances chimiques
Misoprostol
0E43V0BB57
Abortifacient Agents, Nonsteroidal
0
Mifepristone
320T6RNW1F
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
470-475Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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