What is the most effective method of preprocedural cervical dilation for first-trimester surgical abortion?

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EVIDENCE-BASED ANSWERMisoprostol 400 μg, administered vaginally 3 hours before or sublingually 1 hour before first-trimester surgical abortion, is effective for preprocedural cervical dilation but causes more nausea than placebo, especially the sublingual route. Mifepristone may have a greater effect on cervical dilation than misoprostol, but requires dosing 24 hours before the procedure. Vaginal laminaria and vaginal misoprostol are equivalent in terms of need for additional mechanical dilation and average difference in duration of procedure (SOR: C, meta-analysis of RCTs and a noninferiority RCT with disease-oriented outcomes). The Society for Family Planning recommends limiting use of preprocedural cervical ripening medications to patients at increased risk for complications from cervical dilation (SOR: C, expert opinion).

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