Cervical Preparation Before Dilation and Evacuation Using Adjunctive Misoprostol or Mifepristone Compared With Overnight Osmotic Dilators Alone

Abstract

I.

Preoperative effects of mifepristone for dilation and evacuation after 19 weeks of gestation: a randomised controlled trial

“…We demonstrate that using both misoprostol and mifepristone as an adjunct to synthetic osmotic dilators, fewer osmotic dilators achieved a similar cervical dilation compared with dilation reported in previous studies in this gestational age group . Thus, this use of medication adjuncts has the potential to decrease the pain and cost associated with osmotic dilator insertion and is consistent with previous work that focused on reducing from two sets of dilators to one .…”

“…When osmotic dilators and misoprostol are used for cervical preparation, the addition of mifepristone does not seem to shorten procedure times (mean and median difference in procedure time was 1 minute). Previous larger studies showed more benefit with mifepristone as an adjunct to osmotic dilators in gestations >19 weeks and in nulliparous patients . The cost of mifepristone in some settings may be a barrier to its use and additional studies are needed to support routine use of mifepristone as an adjunct to osmotic dilators.…”

“…Studies of mifepristone for medical abortion in the second trimester, showing a 40–50% reduction in abortion times, influenced research on cervical preparation for second trimester surgical abortion and increased the use of mifepristone for cervical preparation prior to D&E . Mifepristone as an adjunct to osmotic dilators decreases the number of osmotic dilators needed after 19 weeks .…”

“…Mifepristone as an adjunct to osmotic dilators decreases the number of osmotic dilators needed after 19 weeks . Although both mifepristone and misoprostol are acceptable alternatives to dilators at 14–16 weeks, misoprostol results in more side effects than mifepristone, including cramping, chills and nausea …”

Management of vaginal wall perforation during a second trimester dilation and evacuation

“…8 Same day procedures are possible with the use of osmotic dilators, especially with the use of Dilapan-S, which dilate quicker (4-6 hours versus 12-24 hour with laminaria) and increase more per volume (4 versus 3 times dehydrated dilator). 12,13 Thus, it is unclear if the use of osmotic dilators decreases the risk of major complications, but several studies have shown improved cervical dilation and provider satisfaction as compared to misoprostol alone.…”