Overnight mifepristone as good as same-day misoprostol for cervical preparation prior to Dilation and Evacuation: Study

This study was published in the journal Contraception by Stephanie Lambert and colleagues. The study conducted at an ambulatory health center, the study included 664 patients initiating abortion between 18 and 22 weeks. The primary outcome was procedure time, with secondary safety outcomes including acute complications and bleeding complications.

The key findings of the study were:

Procedure Time:

• Mifepristone group exhibited a higher mean procedure time (9.7±5.3 minutes vs. 7.9±4.4, p=0.004).

• The difference, though statistically significant, did not reach clinical significance after adjustments.

Additional Medications:

• Additional misoprostol usage was more common in the mifepristone group.

• The use of an additional set of dilators did not differ between the groups.

Acute Complications:

• Similar frequency of acute complications in the misoprostol (4.1%) and mifepristone (4.3%) groups (p=0.90).

While mifepristone prolonged procedure time, the difference was deemed clinically insignificant. Notably, acute complications demonstrated no significant variation between the two methods. This study's insights advocate for the adoption of overnight mifepristone as a viable cervical preparation strategy for Dilation and Evacuation (D&E), offering a balanced perspective on efficacy, safety, and patient-centric considerations.Overnight mifepristone at the time of cervical dilator placement is a safe and effective alternative to adjuvant same-day misoprostol for cervical preparation prior to Dilation and Evacuation (D&E) and may offer benefits for clinic flow and patient experience.

Reference:

Lambert, S. J., Lunde, B., Porsch, L., Stoffels, G., MacIsaac, L., Dayananda, I., & Dragoman, M. V. Adjuvant misoprostol or mifepristone for cervical preparation with osmotic dilators before dilation and evacuation. Contraception,2024;110364:110364.https://doi.org/10.1016/j.contraception.2024.110364