Acute complications with same-day versus overnight cervical preparation before dilation and evacuation at 14 to 16 weeks *

Objective: Evaluate if same-day cervical preparation is associated with a clinically acceptable complication rate compared with overnight osmotic dilators for dilation and evacuation (D&E).Study Design: This retrospective, noninferiority, cohort study compared complication rates for same-day versus overnight cervical preparation with D&E between 14 and 16 weeks gestation. Cervical preparation was achieved with misoprostol, osmotic dilators, or both. Our primary outcome was the acute compli-cation rate, defined as: hemorrhage ( >= 500 mL); hospitalization or hospital transfer; transfusion; or un-planned procedure occurring within 24 hours of the index procedure. Secondarily we evaluated nonma-jor (re-aspiration, suture repair of cervical laceration, uterine tamponade, or emergency department only transfer) and major (transfusion, uterine artery embolization, abdominal surgery, or hospital admission) complications separately. Inverse probability of treatment weighting using the propensity score was used to perform an adjusted analysis, taking into account age, ethnicity, clinic location, insurance, gestational age, gravidity, and prior pregnancy outcomes.Results: We analyzed 1,319 subjects (n = 864 same-day, n = 455 overnight). Same-day cervical prepa-ration patients were more likely to have Medicaid and a prior vaginal delivery. In both unadjusted and adjusted analyses, acute complication rates for same-day were noninferior to overnight preparation (un-adjusted 0.93% vs 1.98%, difference of -1.05%, CI: -2.48% to 0.38%; adjusted difference -0.50%, CI: -1.45 to 0.44%). Only one major complication in the same-day group, a cervical laceration resulting in hemor-rhage requiring transfusion, occurred in the entire sample.Conclusions: In this retrospective review, same-day cervical preparation was noninferior to overnight preparation for D&E between 14 and 16 weeks gestation, both with low complication rates. Implications: For early second trimester dilation and evacuation, same-day cervical preparation should be considered a safe alternative to overnight cervical preparation.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

A retrospective study compared the complication rates of same-day cervical preparation with overnight osmotic dilators for dilation and evacuation (D&E) between 14 and 16 weeks gestation. The study found that same-day cervical preparation had a clinically acceptable complication rate and was noninferior to overnight preparation, with low rates of acute, minor, and major complications.