Misoprostol as an adjunct to overnight osmotic dilators prior to second trimester dilation and evacuation: A systematic review and meta-analysis
To understand effect of adjunct misoprostol on cervical preparation with overnight osmotic dilators for dilation and evacuation after 16 weeks gestation. We searched on-line reference databases using search terms for second trimester, abortion, misoprostol, and dilators. Randomized controlled trials...
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| Published in | Contraception (Stoneham) Vol. 101; no. 2; pp. 74 - 78 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.02.2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0010-7824 1879-0518 1879-0518 |
| DOI | 10.1016/j.contraception.2019.09.005 |
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| Abstract | To understand effect of adjunct misoprostol on cervical preparation with overnight osmotic dilators for dilation and evacuation after 16 weeks gestation.
We searched on-line reference databases using search terms for second trimester, abortion, misoprostol, and dilators. Randomized controlled trials of cervical preparation for second trimester D&E using overnight osmotic dilators comparing adjunct misoprostol to placebo were included. Weighted mean with standard deviation (SD) and pooled binary outcomes were compared.
Among 84 articles identified, three met inclusion criteria (n = 457 subjects) adjunct misoprostol did not significantly decrease mean procedure times (8.5 ± 4.6 vs 9.6 ± 5.8 min, p = 0.78) or manual dilation (18% vs 28%, p = 0.23) when compared to placebo. There was no difference in total complications (p = 0.61), major complications (p = 0.44), or cervical lacerations (p = 0.87).
Current limited evidence suggests adjunct misoprostol with osmotic dilators after 16 weeks does not affect procedure time or need for manual dilation.
Further research is needed to determine the effect of adjunct misoprostol on major complications and blood loss. |
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| AbstractList | To understand effect of adjunct misoprostol on cervical preparation with overnight osmotic dilators for dilation and evacuation after 16 weeks gestation.
We searched on-line reference databases using search terms for second trimester, abortion, misoprostol, and dilators. Randomized controlled trials of cervical preparation for second trimester D&E using overnight osmotic dilators comparing adjunct misoprostol to placebo were included. Weighted mean with standard deviation (SD) and pooled binary outcomes were compared.
Among 84 articles identified, three met inclusion criteria (n = 457 subjects) adjunct misoprostol did not significantly decrease mean procedure times (8.5 ± 4.6 vs 9.6 ± 5.8 min, p = 0.78) or manual dilation (18% vs 28%, p = 0.23) when compared to placebo. There was no difference in total complications (p = 0.61), major complications (p = 0.44), or cervical lacerations (p = 0.87).
Current limited evidence suggests adjunct misoprostol with osmotic dilators after 16 weeks does not affect procedure time or need for manual dilation.
Further research is needed to determine the effect of adjunct misoprostol on major complications and blood loss. To understand effect of adjunct misoprostol on cervical preparation with overnight osmotic dilators for dilation and evacuation after 16 weeks gestation.OBJECTIVETo understand effect of adjunct misoprostol on cervical preparation with overnight osmotic dilators for dilation and evacuation after 16 weeks gestation.We searched on-line reference databases using search terms for second trimester, abortion, misoprostol, and dilators. Randomized controlled trials of cervical preparation for second trimester D&E using overnight osmotic dilators comparing adjunct misoprostol to placebo were included. Weighted mean with standard deviation (SD) and pooled binary outcomes were compared.METHODSWe searched on-line reference databases using search terms for second trimester, abortion, misoprostol, and dilators. Randomized controlled trials of cervical preparation for second trimester D&E using overnight osmotic dilators comparing adjunct misoprostol to placebo were included. Weighted mean with standard deviation (SD) and pooled binary outcomes were compared.Among 84 articles identified, three met inclusion criteria (n = 457 subjects) adjunct misoprostol did not significantly decrease mean procedure times (8.5 ± 4.6 vs 9.6 ± 5.8 min, p = 0.78) or manual dilation (18% vs 28%, p = 0.23) when compared to placebo. There was no difference in total complications (p = 0.61), major complications (p = 0.44), or cervical lacerations (p = 0.87).RESULTSAmong 84 articles identified, three met inclusion criteria (n = 457 subjects) adjunct misoprostol did not significantly decrease mean procedure times (8.5 ± 4.6 vs 9.6 ± 5.8 min, p = 0.78) or manual dilation (18% vs 28%, p = 0.23) when compared to placebo. There was no difference in total complications (p = 0.61), major complications (p = 0.44), or cervical lacerations (p = 0.87).Current limited evidence suggests adjunct misoprostol with osmotic dilators after 16 weeks does not affect procedure time or need for manual dilation.CONCLUSIONCurrent limited evidence suggests adjunct misoprostol with osmotic dilators after 16 weeks does not affect procedure time or need for manual dilation.Further research is needed to determine the effect of adjunct misoprostol on major complications and blood loss.IMPLICATIONSFurther research is needed to determine the effect of adjunct misoprostol on major complications and blood loss. |
| Author | Cahill, Erica P. Shaw, Jonathan G. Shaw, Kate A. Henkel, Andrea |
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| Cites_doi | 10.1016/j.contraception.2016.05.008 10.1016/j.contraception.2010.10.004 10.1016/j.ajog.2005.08.016 10.1016/j.contraception.2013.10.013 10.1016/j.contraception.2008.01.004 10.1016/j.contraception.2005.10.004 10.1016/j.contraception.2014.11.014 10.1016/j.contraception.2012.07.006 10.1097/AOG.0000000000000946 10.1016/j.contraception.2018.01.008 10.15585/mmwr.ss6713a1 10.1097/AOG.0000000000000977 |
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| Keywords | Abortifacient Agents, Nonsteroidal Abortion, Therapeutic Misoprostol Abortion, Induced Cervical preparation Second-trimester abortion Osmotic dilators |
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| SubjectTerms | Abortifacient Agents, Nonsteroidal Abortifacient Agents, Nonsteroidal - administration & dosage Abortion, Induced Abortion, Induced - methods Abortion, Therapeutic Dilatation - methods Extraction, Obstetrical - methods Female Humans Misoprostol Misoprostol - administration & dosage Osmosis Pregnancy Pregnancy Trimester, Second |
| Title | Misoprostol as an adjunct to overnight osmotic dilators prior to second trimester dilation and evacuation: A systematic review and meta-analysis |
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