Cervical Dilation Before First-Trimester Surgical Abortion (<14 Weeks' Gestation)

Publication Date: December 1, 2015
Last Updated: March 14, 2022

Recommendations

Cervical priming in the first trimester with either osmotic dilators or misoprostol may protect against complications such as cervical injury and uterine perforation. The absolute risk of these complications is extremely low. (A)
334012
Cervical priming with misoprostol may reduce the incidence of incomplete abortion. (A)
334012
Effective methods of cervical priming include osmotic dilators and misoprostol; the shortest time for efficacy (2 to 4 h) occurs with the use of Dilapan-S, Lamicel and misoprostol. (A)
334012
When misoprostol is used prior to suction abortion, the optimal dose and timing are 400 mcg vaginally 3 to 4 h, orally 8 to 12 h, buccal 3 to 4 h or sublingually 2 to 4 h before the procedure. (A)
334012
Routine first-trimester cervical priming is not advised because it delays the procedure, is associated with side effects and does not confer proven benefit. (A)
334012
If used, vaginal, oral, buccal and sublingual administration are all acceptable to women. The oral and sublingual routes cause more side effects than vaginal administration. (B)
334012
Osmotic dilators do not increase the postabortal infection rate in the first trimester. (B)
334012
Providers vary in the amount of cervical dilation they attempt to achieve for suction curettage. (C)
334012
Cervical priming should be considered for all adolescents and is strongly recommended for adolescents at 12 to 14 weeks' gestation. (C)
334012
Cervical priming is recommended for all women at 12 to 14 weeks' gestation and for any woman in whom an initial attempt at rigid dilation is difficult. (C)
334012

Recommendation Grading

Overview

Title

Cervical Dilation Before First-Trimester Surgical Abortion (<14 Weeks' Gestation)

Authoring Organization

Publication Month/Year

December 1, 2015

Last Updated Month/Year

August 1, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

It provides guideline regarding first-trimester surgical abortion

Target Patient Population

First-trimester patients requires surgical abortion

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D059408 - Pain Management, D000032 - Abortion, Therapeutic, D000028 - Abortion, Induced, D000023 - Abortion Applicants, D016595 - Misoprostol, D007795 - Laminaria, D004106 - Dilatation

Keywords

abortion, cervical dilation, induced abortion, misoprostol