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.
BACKGROUND
Cervical 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.


METHODS
This 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.


RESULTS
A 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.


CONCLUSIONS
This 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.
bpas, 20 Timothy's Bridge Road, Stratford Enterprise Park, Stratford-upon-Avon, Warwickshire CV37 9BF, UK. Richard.lyus@bpas.org
Richard
R
Lyus
Patricia A
PA
Lohr
Jeanette
J
Taylor
Chelsea
C
Morroni
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000028:Abortion, Induced / Q000379:methods*; D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000187:drug effects*; D004107:Dilatation and Curettage; D004334:Drug Administration Schedule; D005260:Female; D005865:Gestational Age; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D061646:Operative Time; D011108:Polymers / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000020:Abortifacient Agents, Nonsteroidal; D011108:Polymers; D016595:Misoprostol; C077755:dilapan