Cervical priming prior to dilatation and evacuation: A comparison of methods

Vaginal administration of prostaglandin analogues resulted in cervical changes that facilitated dilatation and evacuation in 80 patients in the late first trimester and the second trimester of pregnancy. When 0.5 mg and 1.0 mg of 15(S)-15-methyl-prostaglandin F_2α (15-ME-PGF_2α) was compared to 30 and 60 mg of 9-deoxo-16, 16-dimethyl-9 methylene prostaglandin E₂ (PGE₂ analogue), the PGE₂ analogue appeared to have more cervical ripening effect than did the 15-ME-PGF_2α. Overall, the 30 mg PGE₂ vaginal suppository seemed to offer the most optimal combination of effectiveness, sufficient cervical dilatation, and minimal side effects. With the prostaglandins, maximal cervical effect was observed at 4 to 5 hours; this rapid effectiveness allows administration of the prostaglandin to accommodate a 1-day stay for surgical evacuation. The preoperative cervical priming results with the prostaglandins were compared to those obtained with the use of laminaria tents. Although the number of patients who needed further dilatation at the time of operation was less with the laminaria, the incidence of complications and the time for adequate dilatation were higher in that group.