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

Contraception. 2013 Jan;87(1):71-5. doi: 10.1016/j.contraception.2012.07.006. Epub 2012 Aug 13.


Background: Cervical preparation has been shown to reduce complications with dilatation and evacuation (D&E), but the optimal regimen is unknown. While most published reports are from North America and describe overnight cervical preparation, recent research suggests the safety of same-day cervical preparation up to a gestational age of 18 weeks. We investigated the safety and efficacy of a same-day preparation protocol using a combination of Dilapan-S and misoprostol for gestations of 18-22 weeks.

Study design: This retrospective chart review evaluated 281 consecutive women who had a D&E from 18+0 to 21+6 weeks' gestation at the British Pregnancy Advisory Service clinic in Richmond, London, between January and December 2010. Misoprostol and Dilapan-S osmotic dilators were used in combination for approximately 3 h prior to evacuation. Women who had induced fetal demise were excluded. We evaluated procedure success, duration and the frequency of adverse events.

Results: A total of 274 cases were included in this analysis. In 97% of cases, 400 mcg vaginal misoprostol was used, and in 85% of cases, three Dilapan dilators were inserted. Mean cervical preparation time was 3 h and 40 min (SD 41.2 min), and mean procedure time was 10 min (SD 4.2). There were two immediate complications: one cervical laceration [0.36%, 95% confidence interval (CI) 0.01-2.01] and one extramural delivery in the clinic after cervical preparation agents were placed (0.36%, 95% CI 0.01-2.01). There were no cases of uterine perforation, hemorrhage or inability to complete the procedure.

Conclusion: This study suggests that same-day cervical preparation with Dilapan-S and misoprostol is safe and feasible for second-trimester surgical abortion up to 22 weeks' gestation.

MeSH terms

  • Abortifacient Agents, Nonsteroidal / administration & dosage*
  • Abortifacient Agents, Nonsteroidal / adverse effects
  • Abortion, Induced / methods*
  • Adolescent
  • Adult
  • Cervix Uteri / drug effects*
  • Dilatation and Curettage
  • Drug Administration Schedule
  • Female
  • Gestational Age
  • Humans
  • Misoprostol / administration & dosage*
  • Misoprostol / adverse effects
  • Operative Time
  • Polymers / administration & dosage*
  • Polymers / adverse effects
  • Pregnancy
  • Pregnancy Trimester, Second
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Young Adult


  • Abortifacient Agents, Nonsteroidal
  • Polymers
  • Misoprostol
  • dilapan