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Cervical preparation for dilation and evacuation at 20–24 weeks’ gestation
January 2020, Reaffirmed August 2023, Under revision
Justin T. Diedrich, MD, MSCI; Eleanor A. Drey, MD, EdM; and Sara J. Newmann, MD, MPH
Abortion at or after 14 0/7, Procedural abortion
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Clinical Recommendation

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.

Related Resources
Closing the floodgates: Hemorrhage in second trimester abortion
Medication abortion between 14 0/7 and 27 6/7 weeks of gestation
Bleeding risk assessment and treatment with dilation and evacuation procedures
Related Clinical Guidance
Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation)
Cervical preparation for second-trimester surgical abortion prior to 20 weeks' gestation