Late second trimester dilation and evacuation is a challenging subset of surgical abortion. Among the reasons for this is the degree of cervical dilation required to safely extricate fetal parts. Cervical dilation is traditionally achieved by placing multiple sets of osmotic dilators over two or more days prior to the evacuation procedure; however, there is interest in shortening cervical preparation time. The use of adjuvant mifepristone and misoprostol in conjunction with osmotic dilators has been studied for this purpose, and their use demonstrates that adequate cervical dilation can be achieved in less time than with dilators alone. We present a review of the current evidence surrounding adjunctive agents for cervical preparation, and contend that for women presenting for surgical abortion care above 19 weeks gestation, the use of adjunctive mifepristone and/or misoprostol should be strongly considered along with osmotic dilator insertion when cervical preparation in less than 24 h is needed.
Bibliographical noteFunding Information:
No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Jessika Ralph and Lee Shulman have nothing to disclose. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
© 2019, The Author(s).
- Cervical preparation
- Dilation and evacuation
- Induced abortion