In the realm of abortion care, the debate over cervical preparation methods for Dilation and Evacuation (D&E) procedures has taken center stage. This retrospective cohort analysis aimed to compare the efficacy and safety of two approaches: osmotic dilators plus same-day misoprostol versus overnight mifepristone. Overnight mifepristone proves to be a safe and effective alternative, potentially enhancing clinic flow and patient experience. The study found procedure time to be longer with adjunctive mifepristone compared to misoprostol; however, this difference is unlikely to be clinically meaningful. Furthermore, the frequency of acute complications was similar between groups

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