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Abstract：
First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction aspiration is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester are increasing gestational age and provider inexperience. Use of laminaria for cervical priming reduces the risk of cervical laceration and, to a lesser extent, uterine perforation. While pharmacological priming agents may potentially have the same effects, no published studies to date have been large enough to assess these outcomes. Given an experienced provider, the risk of these injuries during suction aspiration is very small. Cervical priming can be achieved with osmotic dilators or pharmacological agents. The advantages of osmotic dilators such as laminaria, Dilapan-S and Lamicel are their ability to produce wide cervical dilation, and for the synthetic types, their advantages include predictable effects and rapid onset of action. A disadvantage of osmotic dilators is that they require a speculum examination and a trained clinician to perform the insertion. When cervical priming is performed, misoprostol is the prostaglandin analogue most commonly used worldwide. Compared to laminaria, vaginal misoprostol requires a shorter period of time to achieve the same dilatation, is associated with less discomfort and is preferred by women. The sublingual route appears as effective as vaginal administration and requires less time for priming (2 h), but it is associated with more side effects. Oral administration can produce equivalent dilation to vaginal or sublingual administration, but higher doses and longer treatment periods (8 to 12 h) are required. Buccal administration of misoprostol appears to have a pharmacokinetic and physiologic profile similar to vaginal administration; however, there are no published studies of buccal misoprostol prior to first-trimester suction abortion. While extensive data demonstrate that a variety of agents are safe and effective at causing cervical softening and dilation preoperatively, there are not enough data to conclude that routine cervical priming is necessary to reduce complications of first-trimester surgical abortion. Cervical priming increases preoperative cervical dilation, making the procedure easier and quicker for the physician. However, in order to preoperatively dilate the cervix, the woman must receive the agent at least 3 to 4 h prior to her procedure. Besides the additional waiting, the woman might experience bleeding and cramping prior to the procedure. There are insufficient data evaluating how cervical priming affects women\'s quality of life in relation to abortion. Based on existing evidence, the Society of Family Planning does not recommend routine cervical priming for suction aspiration procedures. The Society of Family Planning further recommends that providers consider cervical priming only for women who may be at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be difficult due to either patient factors or provider experience.
摘要：
孕早期手术流产是常见的，安全手术，主要并发症发生率低于1%。在抽吸抽吸之前的宫颈扩张通常使用锥形机械扩张器来完成。妊娠早期主要并发症的危险因素是胎龄增加和提供者缺乏经验。使用海带进行宫颈灌注可降低宫颈裂伤的风险，在较小程度上，子宫穿孔。虽然药理学引发剂可能具有相同的作用，迄今为止,没有发表的研究足以评估这些结局.如果有一个有经验的提供者，抽吸过程中这些伤害的风险很小。宫颈引发可以用渗透性扩张剂或药理学试剂实现。渗透扩张器如海带的优点，Dilapan-S和Lamicel能够产生广泛的宫颈扩张，对于合成类型，它们的优势包括可预测的效果和快速起效。渗透性扩张器的缺点是它们需要窥器检查和受过训练的临床医生来执行插入。当进行子宫颈灌注时，米索前列醇是全球最常用的前列腺素类似物。与海带相比,阴道米索前列醇需要更短的时间才能达到相同的扩张，与较少的不适感有关，是女性的首选。舌下途径似乎与阴道给药一样有效，并且需要更少的启动时间（2小时），但它与更多的副作用有关。口服给药可以产生与阴道或舌下给药相当的扩张，但需要更高的剂量和更长的治疗时间（8至12小时）。米索前列醇的口腔给药似乎具有与阴道给药相似的药代动力学和生理特征；然而，在妊娠早期抽吸流产前,没有关于口腔米索前列醇的已发表研究.虽然大量数据表明，多种药物在术前引起宫颈软化和扩张方面是安全有效的，没有足够的数据得出结论,常规宫颈灌注对于减少妊娠早期手术流产的并发症是必要的.宫颈灌注增加术前宫颈扩张，使医生更容易和更快的程序。然而,为了术前扩张子宫颈，该妇女必须在手术前至少3至4小时接受代理人。除了额外的等待，该妇女在手术前可能会经历出血和抽筋。没有足够的数据来评估宫颈引发与流产相关的如何影响妇女的生活质量。根据现有证据,计划生育协会不建议常规宫颈灌注术用于抽吸抽吸程序。计划生育协会进一步建议提供者仅考虑对可能因宫颈扩张而出现并发症的风险增加的妇女进行宫颈灌注。包括孕早期的那些，由于患者因素或提供者的经验，预计宫颈扩张困难的青少年和女性。
