Cervical preparation for surgical abortion between 12 and 18 weeks of gestation using vaginal misoprostol and Dilapan-S

Abstract

Background We investigated the safety and efficacy of using misoprostol and Dilapan-S™ hygroscopic cervical dilators to prepare the cervix for surgical abortion from 12 to 18 weeks of gestation in an outpatient office setting. Study design This retrospective cohort study evaluated 554 consecutive women who had a surgical abortion from 12 to 18 weeks of gestation using a cervical preparation protocol at Planned Parenthood of Western Pennsylvania between September 2007 and September 2009. Lamicel® osmotic dilators were used for nulliparous women between 12 1/7 and 13 6/7 weeks of gestation and all women 14 to 18 weeks of gestation until September 2008 after which it was no longer available. New guidelines based on available literature included misoprostol 400 mcg vaginally for nulliparous women between 12 1/7 and 13 6/7 weeks of gestation and all women between 14 and 15 6/7 weeks of gestation, and Dilapan-S between 16 and 18 weeks of gestation. Cervical preparation was intended to allow rigid dilation, if necessary, to complete a same-day procedure. We evaluated the ability to complete the procedure on the same day with both protocols and frequency of adverse events. Results A total of 239 and 168 women received a cervical preparation agent under the old and new protocols, respectively. Demographic characteristics were similar between study cohorts. All procedures in both groups were completed on the same day. Severe complications occurred in two women under the old protocol (excessive bleeding with transfer to hospital) and none with the new protocol. Conclusions Early experience for same-day surgical abortion from 12 to 18 weeks of gestation in an outpatient setting using misoprostol and Dilapan-S for cervical preparation is positive in regard to efficacy and safety.