Mifepristone vs. osmotic dilator insertion for cervical prep prior to surgical abortion at 15-18 weeks
Awarded 2011
Large Research Grants
Lynn Borgatta, MD, MPH
Boston Medical Center

Objectives: The objective was to compare the outcomes of surgical evacuation procedures after cervical preparation with either osmotic dilators, or mifepristone followed by misoprostol. This was a non-inferiority design to evaluate whether pharmacologic preparation was significantly worse than osmotic/mechanical dilation. Methods: A randomized controlled trial of 50 women was performed, to compare pharmacologic cervical preparation with mifepristone and misoprostol to mechanical preparation with osmotic dilators. Group 1 was administered mifepristone 200 mg orally 24 hours prior to uterine evacuation plus misoprostol 400 mcg buccally two hours prior to 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 non-inferior to osmotic dilators (median, 14.5 minutes, p = 0.99). Operative time (from intrauterine instrumentation to speculum removal) was also non-inferior (mifepristone median, 7.0 minutes, osmotic dilator median 8.5 minutes, p = 0.51). Initial dilation was less with mifepristone (41F vs 56F), but the final dilation was similar (58F vs 60F). 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.