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Mifepristone and Misoprostol Compared With Osmotic Dilator Insertion Before Surgical Abortion at 15–18 Weeks

Paris, Amy E. MD; Sonalkar, Sarita MD, MPH; Kattan, David MD, MPH; McClusky, Jessica BA; Vragovic, Olivera MBA; Borgatta, Lynn MD, MPH
Obstetrics & Gynecology: May 2014
doi: 10.1097/01.AOG.0000447250.38819.1f
Tuesday, April 29, 2014: PDF Only

BACKGROUND: Cervical preparation is recommended before surgical evacuation of second-trimester pregnancies. Both mechanical (osmotic dilator) and pharmacologic (misoprostol) methods are used in the United States. Mifepristone facilitates medical abortion in the second trimester. The combination of mifepristone and misoprostol may effectively permit evacuation without the need for osmotic dilators.

METHODS: A randomized controlled trial of 50 women was performed to compare pharmacologic cervical preparation with mifepristone and misoprostol with mechanical preparation with osmotic dilators. Group 1 was administered mifepristone 200 mg orally 24 hours before uterine evacuation plus misoprostol 400 mcg buccally 2 hours before the procedure. Group 2 underwent osmotic dilator insertion 24 hours before the procedure. The primary outcome was total procedure time from insertion of the speculum to removal of the speculum.

RESULTS: For total procedure time, mifepristone (median 13.0 minutes) was noninferior to osmotic dilators (median 14.5 minutes, P=.99). Operative time (from intrauterine instrumentation to speculum removal) was also noninferior (mifepristone median 7.0 minutes, osmotic dilator median 8.5 minutes, P=.51). Initial dilation was less with mifepristone (41 French compared with 56 French), but procedure dilation was similar (58 French compared with 60 French). Physicians rated the ease of procedure similarly for both techniques. Women had more cramping and bleeding overnight with osmotic dilators. Women in both groups said they would prefer mifepristone if they ever needed another procedure.

CONCLUSION: Use of a pharmacologic method of cervical preparation did not result in longer procedure times and was acceptable to both operators and patients.

Financial Disclosure: Amy E. Paris, MD; Sarita Sonalkar, MD, MPH; David Kattan, MD, MPH; Jessica McClusky, BA; Olivera Vragovic, MBA; and Lynn Borgatta, MD, MPH—These authors have no conflicts of interest to disclose relative to the contents of this presentation.

© 2014 by The American College of Obstetricians and Gynecologists.