{"id":67957,"date":"2015-07-27T13:20:36","date_gmt":"2015-07-27T17:20:36","guid":{"rendered":"\/news\/?p=67957"},"modified":"2015-07-27T14:22:35","modified_gmt":"2015-07-27T18:22:35","slug":"planned-parenthoods-pre-abortion-dilation-practice-best-women-planned-parenthood","status":"publish","type":"post","link":"https:\/\/archive.liveaction.org\/news\/planned-parenthoods-pre-abortion-dilation-practice-best-women-planned-parenthood\/","title":{"rendered":"Planned Parenthood’s one day second trimester abortion: Better for women, or better for business?"},"content":{"rendered":"
<\/div>

D&E (Dilation and Evacuation) abortions are commonly used for second trimester abortions. These are the abortions that some lawmakers label as \u201cdismemberment\u201d abortions, and they are usually done\u00a0from\u00a016-22 weeks.\u00a0They tend to be more complex because of the size of the baby, and therefore, dilating a woman\u2019s cervix for this procedure is also more complex\u2014and it\u2019s also a subject of debate in medicine.\"BHD209_HRE01\"<\/p>\n

There are two schools of thought on dilating a woman\u2019s cervix prior to a D&E: some use a\u00a0laminaria<\/a>\u00a0(or other osmotic dilator),\u00a0inserted the day before the abortion; some use\u00a0buccal misoprostol\u00a0<\/a>(which most know as a drug used in medication abortions), given the same day as the abortion.<\/p>\n

<\/p>\n

In the\u00a0second Planned Parenthood video<\/a>, Dr. Mary Gatter explains that her Planned Parenthood clinic administers\u00a0misoprostol for every abortion. And starting at about 38:26<\/a>, she also notes\u00a0how the abortionist at her clinic\u00a0uses a\u00a0one-day<\/em> method of cervical dilation for second trimester D&E (Dilation and Evacuation) abortions. Even a 16 week D&E doesn\u2019t get laminaria to dilate for a day prior.<\/p>\n

This saves time, allowing the abortion be completed in a single day, even in the second trimester\u2014and that could be an important factor if a clinic only does abortions one day a week. Once a week abortions are often necessitated by having an itinerant doctor who has limited availability. So, in essence, a one-day abortion makes it easier for the clinic.<\/p>\n

But is it easier on the women<\/em>?<\/p>\n

This time distinction – one day v. multiple days –\u00a0has been the\u00a0subject of\u00a0numerous medical journal articles over the years, one of which was co-authored by Gatter.<\/p>\n

It\u2019s important to note that Gatter\u2019s paper<\/a> was co-authored with seven other people\u2014and every single one of them worked for Planned Parenthood<\/em>. In fact, there\u2019s an additional author listed: \u201cPlanned Parenthood Federation of America Buccal Misoprostol Waiver Group.\u201d In other words, they have a clear stake in the outcome, and yet, the journal in which they published it, Contraception<\/em>, is part of the Elsevier journal group, which requires a disclosure of any conflict of interest<\/a> the parties may have in the research; this is standard in academic journals and is usually published in the article. For example, if a drug company funded research on a drug, even if it was a double-blind study, it still must be disclosed. So it\u2019s important to understand that Planned Parenthood may have had a stake in this research, which is listed as a descriptive study <\/a>–\u00a0one that isn\u2019t experimental, but observational.<\/p>\n

The Planned Parenthood researchers basically came to the conclusion that the drug was the way to go. They briefly admit that wider research is needed but in reading their study, it\u2019s clear it justifies the use of misoprostol in all cases. In the article, they write (emphasis mine):<\/p>\n

\n

Studies have shown that misoprostol can replace laminaria use in some first- and second-trimester abortions.<\/p>\n

In summary, our results concerning adequacy and safety of buccal misoprostol in a cohort of 2218 patients are to be interpreted within the context of the limitations of a descriptive study. A descriptive, noncomparative study does not enable determination of whether observed adverse events are caused by preparation method, procedure, provider, patient history or some other reason.<\/strong> It is with caution and in keeping with the limited evidence in the descriptive studies to date that we conclude that women having second-trimester abortions with buccal misoprostol do not appear<\/strong> to be at increased risk of an adverse event or a serious adverse event\u2026.<\/p>\n

Additional and more rigorous research is needed to identify the safest, most efficient regimen for cervical preparation prior to second-trimester abortion. Buccal misoprostol demonstrates promise to be this cervical preparatory agent.<\/p>\n<\/blockquote>\n

They are correct in determining this topic needs more research, but drawing a conclusion in a non-experimental study that women “do not appear” to be at extra risk seems a stretch. A brief look at the other literature discussing this indicates the same caution but makes no firm conclusions, though it leans toward osmotic dilators like\u00a0laminaria.<\/p>\n

The December 2007 issue of Contraception<\/a>\u00a0also published recommendations from the Society of Family Planning on \u201cCervical preparation for second-trimester surgical abortion prior to 20 weeks of gestation.\u201d In part, it said, acknowledging limitations of current research:<\/p>\n

\n

Routine use of misoprostol as an alternative to osmotic dilation prior to second-trimester D&E is<\/strong> not recommended<\/strong> due to increased risk of inadequate cervical dilation. Buccal or vaginal misoprostol use may be considered by experienced clinicians in lieu of osmotic dilation early in the second trimester (before 16 weeks) in women at low risk for cervical or uterine injury.<\/p>\n

Routine use of adjunctive buccal misoprostol in addition to osmotic dilators for preoperative cervical preparation is<\/strong> not recommended<\/strong> in the early second trimester (before 16 weeks) but may be considered at later gestational ages.<\/p>\n<\/blockquote>\n

Last year, a\u00a0randomized trial of misoprostol versus laminaria before dilation<\/a> concluded that while misoprostol can be safely used, there may be additional work, and skilled physicians<\/em> (not just any practitioners) should be the ones doing it:<\/p>\n

\n

Cervical preparation using either laminaria or misoprostol can be safely used before D&E up to at least 19 weeks. Physicians using misoprostol must be skilled at mechanical dilation, since this is commonly required.<\/p>\n<\/blockquote>\n

In addition, the trial’s results\u00a0noted there was a significant increase in one side effect for the misoprostol group\u2014diarrhea.<\/p>\n

Another randomized trial<\/a> which compared the use of misoprostol to laminaria for early second trimester surgical abortions concluded:<\/p>\n

\n

Early second-trimester abortions take longer and are technically more challenging<\/strong> after cervical ripening with same-day misoprostol than with overnight laminaria, but patients prefer same-day misoprostol\u2026 Much larger comparative trials are necessary to evaluate differences in complication rates.<\/strong><\/p>\n<\/blockquote>\n

These are a few of the many articles that discuss the unresolved sides of these dilation choices. In short, with the varying research and the more technically challenging aspect and possible risk complications of the one-day procedure, it is irresponsible<\/em> for Planned Parenthood to have an across-the-board\u00a0\u201cmisoprostol-only\u201d policy for its D&Es. While it seems it might be safe\u00a0for some, the research with actual randomized trials versus Planned Parenthood\u2019s descriptive study from a decade ago\u2014on which Mary Gatter seems to build a policy in her clinic\u2014is far too mixed to be considered one-size-fits-all.<\/p>\n

However, if Planned Parenthood\u00a0wants to function as an\u00a0assembly line abortion clinic, with\u00a0faster results and same-day second trimester abortion services, it has found the way. The question is, is it the best and safest way for the women it claims to care so much about?<\/em><\/p>\n

The jury is still out on this one, and for now, that could\u00a0put\u00a0women in danger.<\/p>\n","protected":false},"excerpt":{"rendered":"

D&E (Dilation and Evacuation) abortions are commonly used for second trimester abortions. These are the abortions that some lawmakers label as \u201cdismemberment\u201d abortions, and they are usually done\u00a0from\u00a016-22 weeks.\u00a0They tend to be more complex because of the size of the baby, and therefore, dilating a woman\u2019s cervix for this procedure is also more complex\u2014and it\u2019s […]<\/p>\n","protected":false},"author":827,"featured_media":68172,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false},"categories":[8],"tags":[4153,1334,1333,4275,3903,460,4383,14,3567],"yoast_head":"\nPlanned Parenthood's one day second trimester abortion: Better for women, or better for business? - Live Action News<\/title>\n<meta name=\"description\" content=\"Is the use of business-friendly, one-day 2nd trimester abortions at some PP clinics more risky for women than a typical two-day procedure?\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/archive.liveaction.org\/news\/planned-parenthoods-pre-abortion-dilation-practice-best-women-planned-parenthood\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Planned Parenthood's one day second trimester abortion: Better for women, or better for business? 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