Same-day cervical preparation with misoprostol prior to second trimester D&E: a case series.
BACKGROUND
Traditionally, overnight cervical preparation with osmotic dilators has been used for second trimester dilation and evacuation (D&E) procedures. Misoprostol offers an alternative treatment that could shorten cervical preparation time.


METHODS
This study reports on a case series of patients who received only buccal or vaginal misoprostol for cervical preparation on the same day as the D&E procedure. Data were collected from charts of women undergoing second trimester D&E at an outpatient women's health clinic. Eligible cases included procedures performed between January 2001 and December 2010 at 17 0/7 to 23 0/7 weeks of gestation.


RESULTS
Chart review identified 1177 cases of D&E during the study period. After deletion of 96 multiple-day cases using laminaria, 1081 misoprostol-only cases remained for analysis. Two of the cases were not able to be completed in the same day (0.2%). Ninety-eight percent of cases were 17-20 weeks of gestation. The average time from either vaginal or buccal placement of the first misoprostol dose to procedure completion was 4.9 h (SD±1.7 h). The average procedure length was 13.0 min (SD±10.2 min). Complications were reported in 21 of 1079 same-day procedures (2%) and included resuction (n=4), hemorrhage (n=5), cervical laceration (n=4), endometritis (n=5), pulmonary embolus (n=1), disseminated intravascular coagulation (n=1) and perforation (n=1).


CONCLUSIONS
Same-day cervical preparation with misoprostol for second trimester D&E is both safe and effective. With the continuing shortage of D&E providers, the resulting increase in travel distance to obtain the procedure, mandatory waiting periods and the capability of having the procedure completed in a single day may increase patient access, reduce cost and improve patient satisfaction.
University of Utah, Obstetrics and Gynecology, Salt Lake City, UT 84132, USA. Kathryn.maurer@hsc.utah.edu
Kathryn A
KA
Maurer
Janet C
JC
Jacobson
David K
DK
Turok
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000009:adverse effects; D000028:Abortion, Induced / Q000009:adverse effects; D000278:Administration, Buccal; D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects*; D004107:Dilatation and Curettage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008499:Medical Records; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects; D011183:Postoperative Complications / Q000517:prevention & control; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011300:Preoperative Care / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors; D014932:Women's Health Services; D055815:Young Adult
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol