Gynuity Health Projects

Resources

Preoperative effects of mifepristone for dilation and evacuation after 19 weeks of gestation: a randomised controlled trial

OBJECTIVE: To evaluate mifepristone as an adjunct to, or replacement for, osmotic dilators for cervical preparation in surgical abortion after 19 weeks of gestation.

DESIGN: Site-stratified, double-blinded randomised controlled trial.

SETTING: Two tertiary care teaching hospitals.

POPULATION: Women undergoing dilation and evacuation at 19-236/7 weeks of gestation from November 2013 through November 2015.

METHODS: Participants were randomised to receive (1) mifepristone alone (n = 27), (2) osmotic dilators with mifepristone (n = 27) or (3) osmotic dilators with placebo (n = 21) with all receiving pre-procedure misoprostol.

MAIN OUTCOME MEASURES: Operative time, preoperative cervical dilation and complications.

RESULTS: We enrolled 75 participants; mean gestation 21 weeks. Pre-procedure cervical dilation was ≥3 cm in 4, 52, and 57% of participants in groups 1, 2, and 3, respectively (P < 0.005). Mifepristone with misoprostol for cervical preparation resulted in longer procedure times compared with osmotic dilators, with median total procedure times of (1) 18.5 (8-52), (2) 12 (7-25), and (3) 13 (6-26) minutes (P ≤ 0.005). Excluding time required for manual dilation, procedure times were similar: median times from dilation complete to evacuation complete were (1) 10.5 (4-23), (2) 8.5 (5-24), and (3) 10 (4-20) minutes (P = 0.10). Complications occurred in seven cases, six with trainees and one with an attending physician (P = 0.03), with difference by study group not reaching statistical significance (P = 0.12).

CONCLUSIONS: Elimination of osmotic dilators has the potential to decrease burden and opportunity cost of cervical preparation. The longer procedure time, related to manual dilation, is offset by decreasing dilator-related preoperative time and discomfort. Provider experience may impact risk when eliminating dilators.

Access the abstract at BJOG. 2017 Dec;124(13):1973-1981. doi: 10.1111/1471-0528.14900. Epub 2017 Sep 27

  • Topic: Medical Abortion
  • Type: Staff Publications
  • Author: Shaw, K.A., Lerma, K., Shaw, J.G., Scrivner, K.J., Hugin, M., Hopkins, F.W., Blumenthal, P.D.
  • Published: October 2017