Same-day cervical preparation with Dilapan-S plus buccal misoprostol compared with overnight Dilapan-S before dilation and evacuation at 16 to 20 weeks’ gestation: A randomized controlled trial
Awarded 2018
Complex Family Planning Fellowship Research
Chi-Son Kim, MD, MPH
Icahn School of Medicine at Mount Sinai

Dilation and evacuation at 16 to 20 weeks’ gestation is generally performed as a two-day procedure in which cervical dilation is achieved with overnight preparation. When cervical preparation and dilation and evacuation can be performed on the same day, women are spared a multi-day procedure and access to abortion is increased. The Society of Family Planning Level B recommendation that overnight preparation is not necessary prior to 18 weeks’ gestation is based on limited data. Same-day dilation and evacuations are being performed by experienced providers, however comparative data are lacking and necessary to guide practice. No randomized trials compare same-day Dilapan-S™ plus misoprostol with overnight Dilapan-S™, nor have same-day and overnight regimens been compared to 20 weeks. The purpose of this randomized trial is to compare same-day cervical preparation using Dilapan-S™ plus buccal misoprostol to overnight cervical preparation using Dilapan-S™ before dilation and evacuationat 16.0 to 20.0 weeks. Primary objective is to compare dilation and evacuationoperative time. We hypothesize that same-day Dilapan-S™ plus buccal misoprostol is non-inferior to overnight Dilapan-S™ with respect to operative time. The results from this study may be instrumental in informing clinical guidelines and could increase access to dilation and evacuation.