{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T12:33:53Z","timestamp":1770813233322,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2017,9,27]],"date-time":"2017-09-27T00:00:00Z","timestamp":1506470400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000008","name":"David and Lucile Packard Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000008","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate mifepristone as an adjunct to, or replacement for, osmotic dilators for cervical preparation in surgical abortion after 19\u00a0weeks of gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Site\u2010stratified, double\u2010blinded randomised controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Two tertiary care teaching hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women undergoing dilation and evacuation at 19\u201323<jats:sup>6\/7<\/jats:sup> weeks of gestation from November 2013 through November 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants were randomised to receive (1) mifepristone alone (<jats:italic>n<\/jats:italic>\u00a0=\u00a027), (2) osmotic dilators with mifepristone (<jats:italic>n<\/jats:italic>\u00a0=\u00a027) or (3) osmotic dilators with placebo (<jats:italic>n<\/jats:italic>\u00a0=\u00a021) with all receiving pre\u2010procedure misoprostol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Operative time, preoperative cervical dilation and complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We enrolled 75 participants; mean gestation 21\u00a0weeks. Pre\u2010procedure cervical dilation was \u22653\u00a0cm in 4, 52, and 57% of participants in groups 1, 2, and 3, respectively (<jats:italic>P\u00a0<\/jats:italic>&lt; 0.005). Mifepristone with misoprostol for cervical preparation resulted in longer procedure times compared with osmotic dilators, with median total procedure times of (1) 18.5 (8\u201352), (2) 12 (7\u201325), and (3) 13 (6\u201326) minutes (<jats:italic>P\u00a0<\/jats:italic>\u2264<jats:italic>\u00a0<\/jats:italic>0.005). Excluding time required for manual dilation, procedure times were similar: median times from dilation complete to evacuation complete were (1) 10.5 (4\u201323), (2) 8.5 (5\u201324), and (3) 10 (4\u201320) minutes (<jats:italic>P\u00a0<\/jats:italic>=\u00a00.10). Complications occurred in seven cases, six with trainees and one with an attending physician (<jats:italic>P\u00a0<\/jats:italic>=\u00a00.03), with difference by study group not reaching statistical significance (<jats:italic>P\u00a0<\/jats:italic>=\u00a00.12).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Elimination of osmotic dilators has the potential to decrease burden and opportunity cost of cervical preparation. The longer procedure time, related to manual dilation, is offset by decreasing dilator\u2010related preoperative time and discomfort. Provider experience may impact risk when eliminating dilators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Mifepristone and misoprostol for cervical preparation prior to D&amp;E has potential to reduce barriers to care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14900","type":"journal-article","created":{"date-parts":[[2017,8,22]],"date-time":"2017-08-22T05:42:43Z","timestamp":1503380563000},"page":"1973-1981","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Preoperative effects of mifepristone for dilation and evacuation after 19\u00a0weeks of gestation: a\u00a0randomised controlled trial"],"prefix":"10.1111","volume":"124","author":[{"given":"KA","family":"Shaw","sequence":"first","affiliation":[{"name":"Division of Family Planning Services and Research Department of Obstetrics &amp; Gynecology Stanford University School of Medicine Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Lerma","sequence":"additional","affiliation":[{"name":"Division of Family Planning Services and Research Department of Obstetrics &amp; Gynecology Stanford University School of Medicine Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JG","family":"Shaw","sequence":"additional","affiliation":[{"name":"Division of Primary Care and Population Health Department of Medicine Stanford University School of Medicine Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"KJ","family":"Scrivner","sequence":"additional","affiliation":[{"name":"Division of Family Planning Services and Research Department of Obstetrics &amp; Gynecology Stanford University School of Medicine Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Hugin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Santa Clara Valley Medical Center San Jose CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"FW","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Division of Family Planning Services and Research Department of Obstetrics &amp; Gynecology Stanford University School of Medicine Stanford CA USA"},{"name":"Department of Obstetrics &amp; Gynecology Santa Clara Valley Medical Center San Jose CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PD","family":"Blumenthal","sequence":"additional","affiliation":[{"name":"Division of Family Planning Services and Research Department of Obstetrics &amp; Gynecology Stanford University School of Medicine Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,9,27]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"crossref","unstructured":"JonesRK JermanJ.Abortion Incidence and Service Availability In the United States 2014. 2017 20170117[1931\u20102393 (Electronic)].","DOI":"10.1363\/psrh.12015"},{"key":"e_1_2_6_3_1","unstructured":"Department of Health.Report on abortion statistics in England and Wales for 2016. 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