Cervical preparation prior to surgical abortion in real-life conditions and factors driving the prescription: A national observational study

Abstract

IntroductionFew data exist to document the real-life practices regarding surgical abortion for first trimester abortion, in particular regarding the cervical preparation. Using a large national sample of French hospitals practicing surgical abortion, we explore actual practices and described drugs used for cervical preparation and factors that influence the prescription. MethodsFrom December 2013 to July 2014, a longitudinal, prospective, multicenter, non-interventional study was undertaken with the main objective of assessing in real-life conditions the modalities of cervical preparation prior surgical abortion in women with less than 14 weeks of amenorrhea. ResultsA total of 542 patients agreed to participate and were included by 36 French private or public hospitals. Among 36 active centers, 31 (86.1%) implemented cervical preparation prior surgical abortion, in line with French and international clinical guidelines. For the 510 patients who underwent surgical abortions, the most frequent prescribed treatment was misoprostol only (224/510, 43.9% of patients), following by mifepristone only (167/510, 32.8%) and a combination of misoprostol and mifepristone (99/510, 19.4%). Finally, four factors were identified as independent contributor to guide the treatment prescribed for cervical preparation: woman work situation, gestational age intensity of center's activity regarding the number of abortions yearly and mode of anesthesia. ConclusionsOur study showed an almost systematic implementation of cervical preparation before surgical abortion in France. Misoprostol only was the most commonly prescribed treatment for the cervix preparation, followed by mifepristone only. Several factors may have a significant influence on the type of cervical preparation chosen by physicians.