title: Misoprostol 1 to 3 h preprocedure vs. overnight osmotic dilators prior to early second-trimester surgical abortion.
abstract: OBJECTIVE
  We sought to compare the effectiveness of at least 1 h of 400 mcg of buccal misoprostol to overnight osmotic dilators for early second-trimester surgical abortion cervical preparation.
  
  
  METHODS
  We conducted a retrospective cohort study, reviewing 145 consecutive charts to compare procedure duration for women who received 400 mcg of buccal misoprostol at least 1 h preprocedure vs. overnight osmotic dilators before dilation and evacuation between 14 weeks, 0 days and 15 weeks, 6 days' gestation. Primary outcome was procedure duration and secondary outcomes included maximum mechanical dilator size, estimated blood loss and side effects.
  
  
  RESULTS
  Sixty-four women (44.1%) received buccal misoprostol (mean 1.6 h), and 81 women (55.9%) received overnight osmotic dilators. Groups did not differ regarding mean gestational age or gynecologic history. All procedures in both groups were completed. Procedure duration was not significantly different between the misoprostol and osmotic dilator groups (median 11.0 min vs. 10.0 min, p=.22), even after multivariable linear regression (p=.17). The mean total cervical preparation duration was 1.6 h for women in the misoprostol group compared to 20.3 h in the osmotic dilator group (p<.001). Secondary outcomes did not differ between groups.
  
  
  CONCLUSIONS
  We found that at least 1 h of preprocedure misoprostol decreased the duration of cervical preparation for early second-trimester procedures performed by an experienced surgeon.
  
  
  CONCLUSIONS
  In this small, retrospective review, at least 1 h of preprocedure buccal misoprostol decreased the duration from cervical preparation initiation to procedure completion in early second-trimester procedures performed by an experienced surgeon. These results should be considered as a pilot evaluation, and further prospective study is needed to further clarify whether this short interval could be applied in general practice.
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Shanthi
authors.initials: S
authors.lastname: Ramesh
authors.affiliation: Department of Obstetrics and Gynecology, The John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Roston
authors.affiliation: Department of Obstetrics and Gynecology, The John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Zimmerman
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Obstetrics and Gynecology, The John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
authors.forename: Ashlesha
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Family Planning Associates Medical Group, Limited, Chicago, IL, USA.
authors.forename: E Steve
authors.initials: ES
authors.lastname: Lichtenberg
authors.affiliation: Department of Obstetrics and Gynecology, The John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA. Electronic address: jchor@bsd.uchicago.edu.
authors.forename: Julie
authors.initials: J
authors.lastname: Chor
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D007795:Laminaria; D016014:Linear Models; D016595:Misoprostol / Q000008:administration & dosage*; D015999:Multivariate Analysis; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000187:drug effects*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Cervical preparation; Misoprostol; Osmotic dilators; Surgical abortion