Getting termination right: strategies for cervical preparation

We will be discussing Preoperative effects of mifepristone for dilation and evacuation after 19 weeks’ gestation: a randomised controlled trial.  Shaw et al. BJOG 2017 on Wednesday 25 October, 8pm BST.

Scenario

You are performing a surgical termination of pregnancy in the second trimester.
How do you prepare the cervix?

 Description of research

 

Participants 75 participants undergoing termination of pregnancy between
19+0 and 23+6 weeks of pregnancy in two tertiary care teaching
hospitals in California, USA.
Interventions Pre-procedure misoprostol, along with cervical preparation of one
of:
(1) mifepristone alone (n=27),
(2) osmotic dilators with mifepristone (n=27),
(3) osmotic dilators with placebo (n=21)
Comparison Between arms of intervention.
Outcomes Operative time, preoperative cervical dilation and complications,
and participant painm
Study Design Site-stratified, double-blind randomized controlled trial

 

Discussion Points:

  • What were the interventions used in this trial? Do you use these, or others in your clinical practice?
  • How were participants randomised in this trial? What are the advantages and disadvantages of this method?
  • Were participants and clinicians sufficiently blinded in this study?
  • Second trimester termination of pregnancy is a specialist service that requires travel from those women undertaking the procedure. How does this affect the valuation of admission time and repeated visits?
  • Do you agree with the authors’ weighting of pain and procedure length in the conclusions of this study?
  • Are these study’s conclusions strong enough to support practice change?

Suggested reading

Critical Appraisal Skills Programme (2017). CASP Randomised Controlled Trial Checklist. [online] Available at: http://www.casp-uk.net/checklists