Outcomes with same-day cervical preparation with Dilapan-S osmotic dilators and vaginal misoprostol before dilatation and evacuation at 18 to 21+6 weeks’ gestation

Abstract

BackgroundCervical preparation has been shown to reduce complications with dilatation and evacuation (D&E), but the optimal regimen is unknown. While most published reports are from North America and describe overnight cervical preparation, recent research suggests the safety of same-day cervical preparation up to a gestational age of 18 weeks. We investigated the safety and efficacy of a same-day preparation protocol using a combination of Dilapan-S and misoprostol for gestations of 18–22 weeks. Study DesignThis retrospective chart review evaluated 281 consecutive women who had a D&E from 18+0 to 21+6 weeks’ gestation at the British Pregnancy Advisory Service clinic in Richmond, London, between January and December 2010. Misoprostol and Dilapan-S osmotic dilators were used in combination for approximately 3 h prior to evacuation. Women who had induced fetal demise were excluded. We evaluated procedure success, duration and the frequency of adverse events. ResultsA total of 274 cases were included in this analysis. In 97% of cases, 400 mcg vaginal misoprostol was used, and in 85% of cases, three Dilapan dilators were inserted. Mean cervical preparation time was 3 h and 40 min (SD 41.2 min), and mean procedure time was 10 min (SD 4.2). There were two immediate complications: one cervical laceration [0.36%, 95% confidence interval (CI) 0.01–2.01] and one extramural delivery in the clinic after cervical preparation agents were placed (0.36%, 95% CI 0.01–2.01). There were no cases of uterine perforation, hemorrhage or inability to complete the procedure. ConclusionThis study suggests that same-day cervical preparation with Dilapan-S and misoprostol is safe and feasible for second-trimester surgical abortion up to 22 weeks’ gestation.