title: Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation).
abstract: First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction abortion is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester include increasing gestational age and provider inexperience. Cervical priming before first-trimester surgical abortion has been studied using osmotic dilators and pharmacologic agents, most commonly misoprostol. Extensive data demonstrate that a variety of agents are safe and effective at causing preoperative cervical softening and dilation; however, given the small absolute risk of complications, the benefit of routine use of misoprostol or osmotic dilators in first-trimester surgical abortion is unclear. Although cervical priming results in reduced abortion time and improved provider ease, it requires a delay of at least 1 to 3 h and may confer side effects. The Society of Family Planning does not recommend routine cervical priming for first-trimester suction abortion but recommends limiting consideration of cervical priming for women at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be challenging.
authors.affiliation: Women's and Infants' Hospital/Brown University, 101 Dudley Street, Providence, Rhode Island 02905-2401. Electronic address: RHAllen@WIHRI.org.
authors.forename: Rebecca H
authors.initials: RH
authors.lastname: Allen
authors.affiliation: Harvard Medical School, Planned Parenthood League of Massachusetts, 1055 Commonwealth Ave., Boston, Massachusetts 02215-1001. Electronic address: agoldberg@pplm.org.
authors.forename: Alisa B
authors.initials: AB
authors.lastname: Goldberg
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal; D000028:Abortion, Induced / Q000379:methods*; D000293:Adolescent; D004106:Dilatation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D007795:Laminaria; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011365:Professional Practice Location
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Cervical dilation; Dilapan; Laminaria; Misoprostol; Pain; Surgical abortion