Same-day cervical preparation with transcervical Foley catheter and misoprostol prior to midsecond trimester dilation and evacuation: A quasi-experimental study of feasibility and acceptability
Awarded 2021
Complex Family Planning Fellowship Research
Alison Lutz, MD
University of Michigan

Dilation and evacuation (D&E) is the safest and most common method of second trimester abortion. D&E’s safety depends largely on sufficient cervical preparation which traditionally has been done with osmotic dilation. Adequate dilation can be achieved quickly with Dilapan-S allowing for same day procedures, even in the mid-second trimester. Recently, however, the cost of Dilapan-S has increased significantly. Given that patients often have several Dilapan-S placed for cervical preparation, this represents a significant increase in the cost of cervical preparation, which has the potential to further exacerbate inequities already experienced by low-income and marginalized patients. Identifying an alternative method of same-day cervical preparation is critical and there is growing interest in using transcervical Foley catheter (Foley) placement in this setting. While the use of Foley for same-day cervical preparation is backed by the practical experience of skillful surgeons, expert opinion, and abundant data supporting Foley use in other settings, there remains an important research gap, namely documentation of its feasibility, acceptability and effectiveness. To address this gap, we propose a quasi-experimental study at our outpatient abortion clinic to assess the Foley use for cervical preparation prior to mid-second trimester surgical abortion, comparing experience with introduction of Foley use to historical pre-transition data. Our study aims to provide data documenting the Foley’s feasibility and acceptability, potentially offering evidence for an additional method of cervical preparation.