Is it really necessary to prepare the cervix before surgical abortion in early pregnancy? Let's find out

Cervical preparation (promoting cervical ripening and dilation) before surgical abortion aims to make the abortion surgery safer and easier. Osmotic dilators or drug preparations can be used for cervical preparation. To date, there are many methods that can be used for cervical preparation. The methods recommended by professional organizations for cervical preparation may vary depending on the age, number of pregnancies, and gestational age of the pregnant woman.

So, is it really necessary to prepare the cervix before surgical abortion in early pregnancy? If necessary, which cervical preparation is more desirable? Kapp et al. searched the databases of Cochrane, Popline, Embase, Medline and Lilacs, and collected all randomized controlled trials of cervical preparation using drugs or mechanical methods (excluding nitric oxide donors) before surgical abortion in early pregnancy. The results of the analysis showed:

① Compared with placebo, misoprostol (400μg-600μg vaginally or sublingually), gemeprost, mifepristone (200mg or 600mg), prostaglandin E and F2α (2.5mg intracervically) are more effective in cervical preparation.

② Compared with methylprostadil, misoprostol is more effective in preparing the cervix and has less gastrointestinal side effects.

③The effect of vaginal administration of misoprostol 2 hours before surgery is not as good as that of administration 3 hours before surgery.

④ Compared with oral administration, vaginal administration of misoprostol significantly improves the effect of cervical dilation and significantly reduces the incidence of side effects. However, the effect of sublingual administration of misoprostol 2-3 hours before surgery for cervical preparation is better than vaginal administration.

⑤ The effect of misoprostol (600 μg orally or 800 μg vaginally) for cervical preparation is inferior to that of mifepristone (administered 24 hours before surgery).

⑥ Compared with laminaria tents placed 1 day before surgery, vaginal administration of misoprostol 200 μg or 400 μg did not differ significantly in the need for further mechanical cervical dilation and the time required for surgery.

⑦ Similarly, although the effect of prostaglandin on the cervix is ​​better than that of kelp sticks (Lamicel and Dilapan), there is no significant difference between the two in promoting cervical ripening.

⑧ The prostaglandins used earlier (prostaglandin sulfonamide, prostaglandin E2 and F2α) have a higher incidence of gastrointestinal adverse reactions and a higher incidence of spontaneous excretion of pregnancy products before surgery.