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:

1. Lohr PA et al. Abortion.  BMJ 2014;348:f7553
2. Royal college of obstetricians and gynaecologists (RCOG) 2011. The care of women requesting induced abortion. Evidence based clinical guideline number 7.