title: Comparison of the Induction-to-Delivery Interval in Terminations of Pregnancy with or without Dilapan-S®.
abstract: OBJECTIVE
  In France, terminations of pregnancy (TOP) for medical reasons beyond the second trimester use mifepristone and misoprostol. We sought to determine the effectiveness of Dilapan-S®, an osmotic cervical dilator, in shortening the induction-to-delivery interval (IDI).
  
  
  METHODS
  This retrospective study of TOP in 2010-2012 compared the results from 2 hospitals with different TOP protocols starting at 16 weeks' gestation, one (164 women) with and one (106) without Dilapan-S®. The principal endpoint was the IDI. Results were analyzed according to 2 definitions of induction onset: definition 1, first dose of misoprostol in both centers, or definition 2, dilator placement if used, and otherwise first dose of misoprostol.
  
  
  RESULTS
  With definition 1, the IDI was shorter with dilators (5 h 48 min vs. 10 h 18 min, p < 0.001); the rates of uterine evacuation within 12 and 24 h were higher (94.5 and 100 vs. 68.9 and 91.5%, p < 0.001), and the time between first misoprostol dose and amniotomy was shorter (0 h 47 min vs. 4 h 30 min, p < 0.001). Under definition 2, the IDI was longer with dilators (18 h 24 min vs. 10 h 18 min, p < 0.001), but the rate of evacuation within 24 h did not differ significantly.
  
  
  CONCLUSIONS
  Dilapan-S® acts on cervical ripening and dilatation, thereby allowing early amniotomy. Assessing potential side effects and women's satisfaction requires prospective trials.
authors.affiliation: Maternité Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel-Dieu, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Vincienne
authors.forename: Olivia
authors.initials: O
authors.lastname: Anselem
authors.forename: Anne Gaelle
authors.initials: AG
authors.lastname: Cordier
authors.forename: Camille
authors.initials: C
authors.lastname: Le Ray
authors.forename: Vassilis
authors.initials: V
authors.lastname: Tsatsaris
authors.forename: Alexandra
authors.initials: A
authors.lastname: Benachi
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000028:Abortion, Induced / Q000009:adverse effects / Q000295:instrumentation*; D000293:Adolescent; D000328:Adult; D000074885:Amniotomy; D020070:Cervical Ripening; D004106:Dilatation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D010297:Paris; D011108:Polymers; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014590:Uterine Contraction / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D010120:Oxytocics; D011108:Polymers; D016595:Misoprostol; C077755:dilapan
keywords: Dilapan-S®; Dilators; Feticide; Mifepristone; Misoprostol; Second trimester; Termination of pregnancy; Third trimester