Cervical priming before dilation and evacuation in South Africa
Abortion
Awarded 2009
Large Research Grants
Daniel Grossman, MD
Ibis Reproductive Health
$110,500

In South Africa, abortion is legal for several indications up to 20 weeks gestation, and approximately 25%-30% of all abortions take place in the second trimester. Most public sector second trimester procedures are performed by medical induction with misoprostol alone, although in the Western Cape Province, a team of roving doctors provides dilation and evacuation. Cervical priming is achieved using sublingual misoprostol, and laminaria tents are not used. Recent research documented that dilation and evacuation is being performed safely in this setting, and no major complications were observed in a series of 203 procedures. However, 43% of all women undergoing dilation and evacuation expelled the fetus prior to the procedure, and this was often an unexpected and traumatic experience for women. The goal of the proposed project is to improve cervical preparation prior to dilation and evacuation by performing a randomized controlled trial comparing a modified protocol using sublingual misoprostol to one using laminaria. The specific aims of the project are to: 1. Compare the efficacy of sublingual misoprostol cervical priming to laminaria priming among women undergoing dilation and evacuation at 13-20 weeks gestation in the Western Cape Province, South Africa 2. Compare the safety of the two cervical priming regimens by comparing the proportion of women with complications (including fetal expulsion prior to dilation and evacuation) 3. Evaluate the acceptability of the two cervical priming regimens 4. Examine the feasibility of expanding the use of laminaria cervical preparation prior to dilation and evacuation in South Africa The first three aims will be addressed by performing a randomized controlled trial comparing the two cervical priming regimens among women seeking dilation and evacuation at a hospital in Cape Town, South Africa. Clinical information will be collected during and immediately after the procedure, as well as at a follow-up visit 1 week after the dilation and evacuation. Women will also be interviewed immediately after the procedure and at the follow-up visit to assess their acceptability of the procedure. Aim four will be explored by performing in-depth interviews with clinical staff providing dilation and evacuation, nurse managers, department heads, and Provincial Department of Health representatives.

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