Comparative assessment of current cervical preparation methods for surgical abortion and labor induction

Dikke G.B.

Peoples’ Friendship University of Russia, Moscow 117198, Miklukho-Maklaya str. 6, Russia
Objective. To comparatively analyze current methods of cervical preparation for pregnancy termination and labor induction and to determine their benefits.
Material and methods. Publications in the Cochrane databases, guidelines of international and national professional societies, and clinical trials, which have been released into the public domain, were examined.
Results. The review presents the scientific evidence that suggests that osmotic dilators can achieve greater cervical dilation than mifepristone or misoprostol; dilapan is more preferable than laminaria sticks in same-day cervical dilation protocols. Labor induction using mechanical methods compared to prostaglandins results in similar results of cesarean section and in delivery duration of more than 24 hours, but with a lower risk for uterine hyperstimulation and fetal distress. Compared to oxytocin, mechanical methods have a lower risk of cesarean section.
Conclusion. Despite some successes in the development of cervical preparation methods, the most appropriate ones of them have not yet been determined and further investigations are needed to work out more clear recommendations for specific clinical situations.

Keywords

surgical abortion
labor induction
cervical preparation

Supplementary Materials

  1. Table. Characteristics of osmotic dilators of the cervix [8-10]

References

1. Байбарина Е.Н., ред. Основные показатели деятельности акушерско-гинекологической службы в 2012 году. Справочные материалы. М.; 2013. 42с. [Baybarina E.N., ed. The main indicators of the obstetric-gynecological service in 2012. Reference materials. Moscow; 2013. 42p. (in Russian)]

2. Frick A.C., Drey E.A., Diedrich J.T., Steinauer J.E. Effect of prior cesarean delivery on risk of second-trimester surgical abortion complications. Obstet. Gynecol. 2010; 115(4): 760-4.

3. Cervical preparation for second-trimester surgical abortion prior to 20 weeks’ gestation. SFP: Clinical Guidelines. Contraception. 2014; 89: 75-84.

4. Bhattacharya S., Lowit A., Bhattacharya S., Raja E.A., Lee A.J., Mahmood T., Templeton A. Reproductive outcomes following induced abortion: a national register-based cohort study in Scotland. BMJ. 2012; 2(4): e000911.

5. Фаткуллин И.Ф., Мунавирова А.А. Индукция родов. Медицинский советник. 2014; 5: 29-31. [Fatkullin I.F., Munavirova A.A. Induction of childbirth. Meditsinskiy sovetnik. 2014; 5: 29-31. (in Russian)]

6. Allen R.H., Goldberg A.B. Cervical dilation before first-trimester surgical abortion (<14 weeks’ gestation). Contraception. 2016; 93(4): 277-91.

7. Eke A.C., Okigbo C. Mechanical methods for induction of labour: RHL commentary (last revised: 1 August 2012). The WHO Reproductive Health Library. Geneva: World Health Organization. MedGyn Products Inc. Package Insert: Laminaria. Addison, IL; 2012. Available at: https://extranet.who.int/

8. Package Labeling: Dilapan-S™ Hygroscopic Cervical Dilator: Indications for Use. JCEC Co. (Kendall Park, NJ, United States); 2012.

9. Package Labeling: Dilapan-S™ Hygroscopic Cervical Dilator (International Label). Gel-Med International. Available at: http://www.dilapan.com/

10. Borgatta L., Roncari D., Sonalkar S., Mark A., Hou M.Y., Finneseth M., Vragovic O. Mifepristone vs. osmotic dilator insertion for cervical preparation prior to surgical abortion at 14–16 weeks: a randomized trial. Contraception. 2012; 86(5): 567-71.

11. Wilson L.C., Meyn L.A., Creinin M.D. Cervical preparation for surgical abortion between 12 and 18 weeks of gestation using vaginal misoprostol and Dilapan-S™. Contraception. 2011; 83(6): 511-6.

12. Bartz D., Maurer R., Allen R.H., Fortin J., Kuang B., Goldberg A.B. Buccal misprostol compared with Dilapan-S™ before surgical abortion between 12 to 15 weeks gestation. Obstet. Gynecol. 2013; 122: 57-63.

13. Maurer K., Jacobson J., Turok D. Same day cervical preparation with misoprostol prior to second trimester D&E: A case series. Contraception. 2013; 88(1): 116-21.

14. Patel A., Talmont E., Morfesis J., Pelta M., Gatter M., Momtaz M.R. et al. Adequacy and safety of buccal misoprostol for cervical preparation prior to termination of second-trimester pregnancy. Contraception. 2006; 73(4): 420-30.

15. Kapp N., Lohr P.A., Ngo T.D., Hayes J.L. Cervical preparation for first trimester surgical abortion. Cochrane Database Syst. Rev. 2010; (2): CD007207. doi: 10.1002/14651858.CD007207.pub2.

16. Nagaria T., Sirmor N. Misoprostol vs mifepristone and misoprostol in second trimester termination of pregnancy. J. Obstet. Gynaecol. India. 2011; 61(6): 659-62.

17. Goldberg A.B., Drey E.A., Whitaker A.K., Kang M.S., Mecksroth K.R., Darney P.D. Misoprostol compared with laminaria before early second-trimester surgical abortion: a randomized trial. Obstet. Gynecol. 2005; 106(2): 223-41.

18. Drezett J., Bessa M.M., Pedroso D., Silva A.C.F. et al. Misoprostol no aborto de segundo trimestre em gestações decorrentes de violência sexual: análise de efetividade de um protocolo aplicado em serviço público de saúde brasileiro. Reprod. Climat. 2014; 29(3): 105-11.

19. American College of Obstetricians and Gynecologists. Practice Bulletin No.135: Second-trimester abortion. Obstet. Gynecol. 2013; 121(6): 1394-406.

20. Royal College of Obstetricians and Gynaecologists. The care of women requesting induced abortion (Evidence-based Clinical Guideline No.7). London: RCOG Press; 2011. 130p.

21. Carbonell J.L., Gallego F.G., Llorente M.P., Bermudez S.B., Sala E.S., González L.V., Texido C.S. Vaginal vs. sublingual misoprostol with mifepristone for cervical priming in second-trimester abortion by dilation and evacuation: a randomized clinical trial. Contraception. 2007; 75(3): 230-7.

22. Hammond C., Chasen S. Dilation and evacuation. In: Paul M., Lichtenberg E.S., Borgatta L., Grimes D.A., Stubblefield P.G., Creinin M.D. eds. Management of unintended and abnormal pregnancies: comprehensive abortion care. Wiley-Balckwell; 2009: 157-77.

23. Patsner B. Same-day Dilapan insertion before second-trimester dilation and evacuation for a fetal anomaly or death. J. Reprod. Med. 1996; 41: 71-2.

24. Lyus R., Lohr P.A., Taylor J., Morroni C. Outcomes with same-day cervical preparation with Dilapan-S osmotic dilators and vaginal misoprostol before dilatation and evacuation at 18 to 21+6 weeks’ gestation. Contraception. 2013; 87(1): 71-5.

25. Кан Н.Е., Баранов И.И., Тютюнник В.Л. Нерешенные вопросы безопасного досрочного завершения беременности в России. В кн.: Доклад на XVII Всероссийском научно-образовательном форуме «Мать и дитя – 2016». Москва, 27-30 сентября 2016 года. [Kan N.Ye., Baranov I.I., Tyutyunnik V.L. Unresolved issues of safe early termination of pregnancy in Russia. In the book .: Report at the XVII All-Russian Scientific and Educational Forum “Mother and Child – 2016”. Moscow, September 27-30, 2016. (in Russian)]

26. Баринов С.В., Тирская Ю.И., Шамина И.В., Медянникова И.В., Шкабарня Л.Л. Применение осмотического расширителя при несостоявшемся выкидыше у женщин с тяжелой сопутствующей патологией для прерывания беременности. Акушерство и гинекология. 2017; 3: 160-4. http://dx.doi.org/10.18565/aig.2017.3.160-4 [Barinov S.V., Tirskaya Yu.I., Shamina I.V., Medyannikova I.V., Shkabarnya L.L. Use of an osmotic dilator in cases of incomplete abortion to terminate miscarriage in women with severe comorbidity. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (3): 160-4. (in Russian) http://dx.doi.org/10.18565/aig.2017.3.160-4]

27. Chambers D.G., Willcourt R.J., Laver A.R., Baird J.K., Herbert W.Y. Comparison of Dilapan-S and laminaria for cervical priming before surgical pregnancy termination at 17-22 weeks’ gestation. Int. J. Womens Health. 2011; 3: 347-52.

28. Lichtenberg E.S. Complications of osmotic dilators. Obstet. Gynecol. Surv. 2004; 59(7): 528-36.

29. Chanda M., Mackenzie P., Day J.H. Hypersensitivity reactions following laminaria placement. Contraception. 2000; 62(2): 105-6.

30. Kim S.H., Chang Y.H., Kim W.K., Kim Y.K., Cho S.H., Kim Y.Y., Min K.U. Two cases of anaphylaxis after laminaria insertion. J. Korean Med. Sci. 2003; 18(6): 886-8.

31. Peterson W.F., Berry F.N., Grace M.R., Gulbranson C.L. Second-trimester abortion by dilatation and evacuation: an analysis of 11,747 cases. Obstet. Gynecol. 1983; 62(2): 185-90.

32. Sutkin G., Capelle S.D., Schlievert P.M., Creinin M.D. Toxic shock syndrome after laminaria insertion. Obstet. Gynecol. 2001; 98(5, Pt 2): 959-61.

33. Halperin R., Vaknin Z., Langer R., Bukovsky I., Schneider D. Late midtrimester pregnancy termination in the presence of placenta previa. J. Reprod. Med. 2003; 48(3): 175-8.

34. Ferguson J.K.W. A study of the motility of the intact uterus at term. Surg. Gynecol. Obstet. 1941; 73: 359-66.

35. Jozwiak M., Bloemenkamp K.W., Kelly A.J., Mol B.W., Irion O., Boulvain M. Mechanical methods for induction of labour. Cochrane Database Syst. Rev. 2012; (3): CD001233.

36. Maier J.T., Schalinski E., Gauger U., Hellmeyer L. Cervical ripening with an osmotic dilator (Dilapan-S) in term pregnancies – An Observational Study. J. Gynecol. Neonat. Biol. 2015; 1(3): 1-6.

37. Reinhard J., Raddatz R., Langer R., Fessler S., Kaufmann C., Nteli V.A. et al. Pilot study. Mechanical versus pharmacological term induction: a cohort group analysis of maternal and neonatal outcome – hygroscopic cervical dilator versus prostaglandin E2. Clin. Obstet. Gynecol. Reprod. Med. 2016; 2. doi: 10.15761/COGRM.1000154. https://www.oatext.com/

38. Chodankar R., Sood A., Gupta J.K. An overview of the past, current and future trends for cervical ripening in induction of labour. TOC. 2017; 19(3): 219-26.

39. Jozwiak M., Dodd J.M. Methods of term labour induction for women with a previous caesarean section. Cochrane Database Syst. Rev. 2013; (3):CD009792.

40. SOGC Clinical Practice Guideline. Induction of labour. No. 296, September 2013. (Replaces No. 107, August 2001)

41. Евтушенко И.Д., Махмутходжаев А.Ш., Иванова Т.В., Паршина О.В., Рыжова И.А., Куфарева Т.И., Попова В.Н. Применение синтетического аналога простагландина Е1 для подготовки шейки матки и индукции родов. Бюллетень сибирской медицины. 2003; 3: 75-80. [Yevtushenko I.D., Makhmutkhodzhayev A.Sh., Ivanova T.V., Parshina O.V., Ryzhova I.A., Kufareva T.I., Popova V.N. The use of a synthetic analogue of prostaglandin E1 for the preparation of the cervix and the induction of labor. Byulleten’ sibirskoy meditsiny. 2003; 3:75–80. (in Russian)]

42. Hapangama D., Neilson J.P. Mifepristone for induction of labour. Cochrane Database Syst. Rev. 2009; (3): CD002865.

43. Серов В.Н., Сухих Г.Т., ред. Клинические рекомендации. Акушерство и гинекология. 4-е изд. М.: ГЭОТАР-Медиа; 2014. 1024с. [Serov V.N., Sukhikh G.T., ed. Clinical recommendations. Obstetrics and gynecology. 4th ed. Moscow: GEOTAR-Media; 2014. 1024p. (in Russian)]

44. Синчихин С.П., Мамиев О.Б., Галкина Н.Н., Акушкова Л.М., Печенкин В.Г. Клиническая эффективность применения мифепристона при доношенной беременности. Акушерство и гинекология. 2009; 5: 56-7. [Sinchikhin S.P., Mamiyev O.B., Galkina N.N. Akushkova LM, Pechenkin V.G. Clinical efficacy of mifepristone in term pregnancy. Akusherstvo i ginekologiya/Obstetrics and gynecology. 2009; 5: 56-7. (in Russian)]

45. Миляева Н.М., Ковалев В.В., Лебедева Л.М. Оценка эффективности и безопасности применения Мифепристона для преиндукции и индукции родов. Вопросы гинекологии, акушерства и перинатологии. 2007; 6(4): 18-21. [Milyayeva N.M., Kovalev V.V., Lebedeva L.M. Evaluation of the efficacy and safety of Mifepristone for pre-induction and induction of labor. Voprosy ginekologii, akusherstva i perinatologii. 2007; 6(4): 18–21. (in Russian)]

46. Хворостухина Н.Ф., Леонова А.М., Новичков Д.А., Яценко Д.С. Опыт применения мифепристона при подготовке шейки матки к родам при доношенном сроке беременности. Современные проблемы науки и образования. 2016; 1: 14. Available at: https://www.science-education.ru/ [Khvorostukhina N.F., Leonova A.M., Novichkov D.A., Yatsenko D.S. Experience in the use of mifepristone in preparing the cervix for childbirth at a term of term pregnancy. Sovremennyye problemy nauki i obrazovaniya (el. nauch. zhurnal). 2016; 1: 14. Available at: https://www.science-education.ru/ (in Russian)]

47. Баев О.Р., Румянцева В.П. Оптимизация подходов к применению мифепристона в подготовке к родам. Акушерство и гинекология. 2012; 6: 69-73. [Bayev O.R., Rumyantseva V.P. Optimization of approaches to using mifepristone to prepare for labor. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2012; (6): 69-73. (in Russian)]

48. Баев О.Р., Тысячный О.В., Румянцева В.П., Усова Е.А. Эффективность подготовки шейки матки и родовозбуждения в схеме с использованием антипрогестина мифепристон. Медицинский совет. 2015; 9: 72-6. [Bayev O.R., Tysyachnyy O.V., Rumyantseva V.P., Usova Ye.A. Efficacy of cervical and birth excitation in a scheme using the antiprogestin mifepristone. Meditsinskiy sovet. 2015; 9: 72-6. (in Russian)]

49. Saad A., Gupta J., Maier J., Hruban L., Mehta P., Baev O. Synthetic osmotic dilator prior to induction of labor: Outcomes from International Observational E-Registry [13C]. Obstet. Gynecol. 2017, May. Available at: http://journals.lww.com/greenjournal/

50. Баев О.Р., Румянцева В.П., Кан Н.Е., Тетруашвили Н.К., Тютюнник В.Л., Ходжаева З.С., Адамян Л.В., Сухих Г.Т. Подготовка шейки матки к родам и родовозбуждение. Клинический протокол. М.; 2012. 18с. [Bayev O.R., Rumyantseva V.P., Kan N.E., Tetruashvili N.K., Tyutyunnik V.L., Khodzhaeva Z.S., Adamyan L.V., Sukhikh G.T. Preparation of the cervix for childbirth and induction. Clinical protocol. Moscow; 2012. 18p. (in Russian)]

Received 16.06.2017

Accepted 23.06.2017

About the Authors

Galina B. Dikke, Honored Scientist and Education Worker, MD, Professor of the Department of Obstetrics, Gynecology and Reproductive Medicine, Faculty of Advanced Training of Medical Workers, Peoples’ Friendship University of Russia. 117198, Russia, Moscow, Miklukho-Maklaya str. 6. Tel.: +74954345300. E-mail: galadikke@yandex.ru

For citations: Dikke G.B. Comparative assessment of current cervical preparation
methods for surgical abortion and labor induction.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (9): 12-9. (in Russian)
http://dx.doi.org/10.18565/aig.2017.9.12-9

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