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

Adjunctive Agents for Cervical Preparation in Second Trimester Surgical Abortion

“…The overall complication rate was 1.8% in a review of 274 patients, comparable to similar published rates using overnight cervical preparation regimens. It is important to note that patient selection by providers may have biased the results by choosing only those participants at lowest risk of abortion complications at baseline, as evidenced by the low rate of women with prior cesarean (~ 7%) [16]. Boraas et al followed with a randomized trial of adjunctive misoprostol in women between 16 and 20 6/7 weeks receiving same-day cervical preparation with Dilapan-S. With regard to the primary outcome of procedure time, no difference was found between the misoprostol and placebo group (11.1 vs 13.5 min, p = 0.17); however, the study was closed prematurely because of two severe adverse events in the placebo group and was therefore underpowered.…”

“…The optimal dose, time interval, and route of misoprostol for adjuvant use have not been determined, and administration varied among the above studies. The most frequently used dose is 400 µg [12, 13, 16], inferred from dosage studies in first trimester surgical abortion which demonstrated that dosages above 400 µg increased side effects without improving cervical dilation [18]. Buccal administration is often chosen in studies of adjunctive cervical preparation [12–14, 16], as it is unknown whether vaginal administration is affected by the presence of dilators and/or sponges; however, the large series by Lyus et al demonstrates efficacy with vaginal administration [16].…”

“…The most frequently used dose is 400 µg [12, 13, 16], inferred from dosage studies in first trimester surgical abortion which demonstrated that dosages above 400 µg increased side effects without improving cervical dilation [18]. Buccal administration is often chosen in studies of adjunctive cervical preparation [12–14, 16], as it is unknown whether vaginal administration is affected by the presence of dilators and/or sponges; however, the large series by Lyus et al demonstrates efficacy with vaginal administration [16]. Time interval is often informed by studies of vaginally administered misoprostol, demonstrating that peak effect occurs between 3 and 4 h after administration [19], but shorter time intervals have been shown to be efficacious [20].…”

Cervical preparation prior to second-trimester surgical abortion and risk of subsequent preterm birth

“…The need for more directive guidance is pressing. Many UK providers continue to use same-day cervical preparation protocols for D&E13 right up to 24 weeks’ gestation 14. Thousands of women each year are undergoing surgical abortion with protocols that may be associated with an increased risk of PTB, when alternatives with more reassuring data supporting their use are available.…”

Cervical ripening with an osmotic dilator (Dilapan-S) in term pregnancies – An observational study

“…Some are hydrophilic agents made from sterile sea weed (known as laminaria tents) or synthetic materials (such as Dilapan-S or Dilasoft) that function through gradual radial expansion of the cervical canal as well as stimulating the release of endogenous prostaglandin and oxytocin [3,4] . To date, Dilapan-S has been described in literature as a useful tool in cervical preparation prior to dilation and evacuation in induced abortion < 20 gestational weeks [4,5] . Dilapan-S is a tiny rod made from synthetic hydrophilic material (Aquacryl 90) attached to a polypropylene handle.…”