Schneider and associates (1991) described 21 cases in which women who had a hygroscopic dilator placed changed their minds. Of 17 women who chose to continue their pregnancy, there were 14 term deliveries, two preterm deliveries, and one miscarriage 2 weeks later. None sufered infection-related morbidity, including three untreated women with cervical cultures positive for Chlamydia trachomatis. In similar circumstances with four second-trimester terminations, Siedhof and Cremer (2009) described two preterm and two term deliveries.
Instead of hygroscopic dilators, misoprostol is often used for cervical ripening. he typical dose is 400 �g administered sublingually, buccally, or placed into the posterior vaginal fornix 3 to 4 hours prior to surgery. Instead, oral administration proves less efective and may take longer (Allen, 2016). Another efective cervical-ripening agent is the antiprogestin mifepristone, 200 mg given orally 24 to 48 hours before surgery (Ashok, 2000). Its cost and greater delay to the procedure, however, typically favor misoprostol use instead.
In comparing hygroscopic dilators and misoprostol for ripening, randomized studies show equal or slightly greater dilation with hygroscopic dilators. Other surgical parameters do not vary significantly (Bartz, 2013; Burnett, 2005; Macisaac, 1999). Hygroscopic dilators extend procedure time and can be uncomfortable, whereas misoprostol introduces fever, bleeding, and gastrointestinal side efects.
If not done as part of early prenatal care, hemoglobin level and h status are assessed. Screening for gonorrhea, for syphilis, and for human immunodeficiency virus, hepatitis B, and chlamydial infections is also completed. Obvious cervical infections are treated and resolved before elective procedures. To prevent postabortal infection after a first-or second-trimester surgical evacuation, prophylactic doxycycline, 100 mg orally 1 hour before and then 200 mg orally after, is provided (Achilles, 2011; American College of Obstetricians and Gynecologists, 20 16a). Prophylaxis specifically for infective endocarditis prevention in those with valvular heart disease is not required in the absence of active infection (Nishimura, 2017). No recommendations speciically address venous thromboembolism prophylaxis for suction curettage in low-risk gravidas. At our hospital, we encourage early ambulation.
lso called suction dilation and curettage or suction curettage, vacuum aspiration is a transcervical approach to surgical abortion. he cervix is first dilated and then products of conception are evacuated. For this, a rigid cannula is attached either to an electric-powered vacuum source or to a handheld GO-mL syringe for its vacuum source. hese are electric vacuum aspiration (EVA) or manual vacuum aspiration (MVA), respectively. Sharp dilation and curettage (D -C) in which contents are mechanically scraped out soley by a sharp curette is currently not recommended for pregnancy evacuation due to greater blood loss, pain, and procedural time (National Abortion Federation, 2016; World Health Organization, 2012). Importantly, this practice is distinguished from brief sharp curettage following initial aspiration. In one survey, this combination is employed by nearly 50 percent of abortion providers (O'Connell, 2009).