This document is currently under revision.
Clinical guidance is rigorously developed to reflect the best available evidence at the time of publication. It is designed as a resource to assist clinicians in providing family planning care. It is not intended to substitute for the independent professional judgment of the treating clinician. We recognize that continued research, new understandings of person-centered care, or major changes in the legal landscape can impact clinical guidance. It should not be considered inclusive of all proper treatments or serve as the standard of care. Variations, taking into account individual circumstances, may be appropriate.

Although only 1.3% of abortions in the United States are between 20 and 24 weeks’ gestation, these procedures are associated with elevated risks of morbidity and mortality. Adequate cervical preparation before dilation and evacuation (D&E) at 20–24 weeks’ gestation reduces procedural risk. For this gestational range, at least one day of cervical preparation with osmotic dilators is recommended before D&E. The use of overnight osmotic dilators alone is sufficient for most D&Es at 20–24 weeks’ gestation.