Adjunct mifepristone for cervical preparation prior to dilation and evacuation: a randomized trial

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

“…We demonstrate that using both misoprostol and mifepristone as an adjunct to synthetic osmotic dilators, fewer osmotic dilators achieved a similar cervical dilation compared with dilation reported in previous studies in this gestational age group . Thus, this use of medication adjuncts has the potential to decrease the pain and cost associated with osmotic dilator insertion and is consistent with previous work that focused on reducing from two sets of dilators to one . The insertion of fewer osmotic dilators offsets the additional cost of mifepristone without increasing side effects or pain, as mifepristone alone did not increase pre‐procedure pain.…”

“…Clinical inferiority was defined a priori as a more than 7‐minute difference in operative time between any of the three distinct cervical preparations. In previous studies, operative procedure times were normally distributed with a standard deviation of ~5 minutes; we rationalised that up to a 7‐minute difference in procedure time would be represent a clinically acceptable difference between groups given the elimination of the additional preoperative time and discomfort associated with osmotic dilator insertion. Fourteen participants per group were required to show equivalence within 7 minutes for the procedure with a one‐sided alpha of 0.025 and power of 0.90.…”

“…On the day of the procedure, all participants received buccal misoprostol 400 μ g preoperatively, with timing determined by study arm: 90 minutes prior to procedure for those with osmotic dilators and 2–3 hours for those without . Cervical dilation was assessed after administration of misoprostol via bimanual exam by the surgeon; if cervical dilation was <1 cm, a second dose of 400 μ g buccal misoprostol for 2–4 hours was permitted per provider discretion.…”

“…Studies of mifepristone for medical abortion in the second trimester, showing a 40–50% reduction in abortion times, influenced research on cervical preparation for second trimester surgical abortion and increased the use of mifepristone for cervical preparation prior to D&E . Mifepristone as an adjunct to osmotic dilators decreases the number of osmotic dilators needed after 19 weeks .…”

Cervical Preparation Before Dilation and Evacuation Using Adjunctive Misoprostol or Mifepristone Compared With Overnight Osmotic Dilators Alone

“…18 A recent randomized trial compared overnight osmotic dilators plus mifepristone and misoprostol with 2 days of osmotic dilators plus misoprostol before dilation and evacuation at 19-23 6/7 weeks of gestation and found no difference in procedure time or initial cervical dilation between groups. 19 We hypothesized that adjunctive misoprostol 3 hours preoperatively or mifepristone at the time of osmotic dilator placement would improve cervical preparation before dilation and evacuation at 16-23 6/7 weeks of gestation, making surgery easier and faster than preparation with osmotic dilators alone.…”