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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents results from a prospective randomized clinical trial demonstrating that when compared with mechanical methods, pharmacologic cervical preparation does not prolong procedure times in patients undergoing surgical evacuation of second-trimester pregnancies and is acceptable to both operators and patients [Paris AE et al. \u003Cem\u003EObstet Gynecol\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EObstetrics \u0026amp; Gynecology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPregnancy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiagnostic \u0026amp; Surgical Procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EObstetrics \u0026amp; Gynecology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObstetrics \u0026amp; Gynecology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPregnancy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiagnostic \u0026amp; Surgical Procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAmy E. Paris, MD, Boston University School of Medicine, Boston, Massachusetts, USA, presented results from a prospective randomized clinical trial demonstrating that when compared with mechanical methods, pharmacologic cervical preparation does not prolong procedure times in patients undergoing surgical evacuation of second-trimester pregnancies and is acceptable to both operators and patients [Paris AE et al. \u003Cem\u003EObstet Gynecol\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ECervical preparation is recommended before surgical evacuation of second-trimester pregnancies, and in the United States, it is achieved via mechanical methods (osmotic dilators [ODs]), pharmacologic agents (misoprostol and mifepristone), or a combination of both techniques [Fox. \u003Cem\u003EContraception\u003C\/em\u003E 2014; Newmann. \u003Cem\u003ECochrane Database Syst Rev\u003C\/em\u003E 2010]. Mifepristone is considered more effective than misoprostol for first-trimester surgical abortion and between 14 and 16 weeks of gestation, but it is noninferior to ODs with respect to procedure time [Borgatta L et al. \u003Cem\u003EContraception\u003C\/em\u003E 2012; Kapp N et al. \u003Cem\u003ECochrane Database Syst Rev\u003C\/em\u003E 2010; Carbonnel JL et al. \u003Cem\u003EContraception\u003C\/em\u003E 2007]. The combination of mifepristone and misoprostol may also effectively permit evacuation, and it has been shown to be more effective than misoprostol alone for second-trimester surgical abortion.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAlthough prostaglandins and ODs have been used and studied as cervical preparations before second-trimester surgical abortion, there is no consensus as to which method is superior with regard to safety, procedure time, need for additional dilation, ability to perform the procedure, or patient and physician acceptability [Newmann SJ et al. \u003Cem\u003ECochrane Database Syst Rev\u003C\/em\u003E 2010]. With this in mind, Prof. Paris and colleagues conducted a randomized controlled study to compare the efficacy of pharmacologic versus mechanical cervical preparation before surgical evacuation at 15 to 18 weeks.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary endpoint of the study was total abortion time (from insertion of the speculum to its removal) and total operative time. Secondary outcomes were operator-and patient-related experiences.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EFifty women (age, 18 to 45 years; gestational age, 15 to 18 weeks) undergoing surgical abortion were prospectively and randomly assigned to 2 cervical preparation groups. Baseline characteristics were similar in both groups (mean age, 26 years; mean gestational age, 16\u00b12 weeks; 30% were nulliparous; 20% had undergone a previous second-trimester surgical abortion via ODs).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EWomen in the pharmacologic preparation group received mifepristone (200 mg, orally) 24 hours before the procedure and misoprostol (400 \u03bcg, buccally) 2 hours before. Those in the mechanical preparation group underwent OD insertion 24 hours before the procedure.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThere was no difference between the pharmacologic and OD groups in the primary outcome of median total abortion time (13.5 vs 14.0 minutes; p=0.99) and operative time (from intrauterine instrumentation to speculum removal; 7.0 vs 8.5 minutes; p=0.51).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EWith respect to secondary outcomes, physicians rated the ease of procedure similarly for both methods. However, women in the OD group reported more discomfort overnight and indicated that they would prefer mifepristone if they ever needed another procedure.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EProf. Paris concluded that the use of mifepristone, followed by misoprostol, for cervical preparation is as effective as overnight ODs for cervical preparation before surgical abortion for up to 18 weeks and does not result in longer procedure times. She also stated that women prefer the pharmacologic preparation method because it is associated with less procedural discomfort.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/7\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp98d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}