Clinical obstetrics and gynecology
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Dilation and evacuation, the most common method performed for second-trimester abortion in the United States, requires sufficient cervical dilation to reduce the risk of complications such as cervical laceration or uterine perforation. The cervix may be prepared with osmotic dilators such as laminaria, Lamicel, or Dilapan-S, or with pharmacologic agents such as misoprostol. ⋯ Misoprostol has limited data supporting its use in this setting. Decisions regarding which method is best are clinician-dependent, and factors such as gestational age and time allowed for preparation should be considered.
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Infectious complications are a significant source of morbidity and mortality associated with pregnancy termination worldwide. However, in areas where abortion practices are legal, the risk of infection is very low. Proper technique, prophylaxis, and initial management of septic abortion have led to a significant decrease in risk of serious complications such as sepsis and death. Clinical features, management, and prevention of postabortal infection will be reviewed in the setting of legalized abortion.
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Women continue to die from pregnancy-related causes at an alarming rate. Maternal mortality was first called a neglected epidemic in 1985, but to date, no significant improvements have been realized. Great disparity exists as lifetime risk of dying from pregnancy is 1 in 26 in Africa, 1 in 7300 in high-income areas. The UN Millennium Development Goals call for a 75% reduction in maternal mortality by 2015, which will only be realized when priority setting, funding, and program implementation can create conditions for appropriate human resources, infrastructure, and patient education for high-quality obstetric care.