Twenty-Four Hour Mifepristone Combined With Vaginal Versus Buccal Misoprostol Prior to D&E [7G

Abstract

INTRODUCTION: The goal of this study was to evaluate oral mifepristone twenty-four hours prior to vaginal versus buccal misoprostol as cervical preparation prior to second-trimester dilation and evacuation (D&E). METHODS: Women desiring abortion between gestational ages 16 weeks 0 days and 20 weeks 6 days were randomized to 200-mg mifepristone 20-24 hours and 400-mcg vaginal or 400-mcg buccal misoprostol 1-2 hours prior to D&E. Primary outcome was intraoperative procedure time defined as time of initial cervical dilation assessment to speculum out. Secondary outcomes included initial Pratt dilator accepted without resistance and participant and provider perceptions. The study was powered to detect a 4-minute difference in procedure time with 36 participants in each arm. RESULTS: Of 72 women enrolled, 70 were randomized and completed the study. Age, BMI, gestational age (mean 18.7 weeks, SD 1.39), and parity did not significantly differ. Total procedure times were 9.4 and 10.6 minutes in the vaginal and buccal groups, respectively, with difference of 1.2 (95% CI -1.2, 3.8). Initial Pratt dilation was 49.6 and 45.6 Fr in the vaginal and buccal groups, respectively, with difference of 4 Fr (95% CI -9.0, 1.0). Participant and provider perceptions did not differ. All 70 procedures were completed without hemorrhage, cervical laceration, or other observed complications. CONCLUSION: Mifepristone 24 hours prior combined with vaginal or buccal misoprostol 2 hours prior is effective as cervical preparation for D&E at 16 weeks through 20 weeks 6 days.