Adjunctive Agents for Cervical Preparation in Second Trimester Surgical Abortion

Jessika A. Ralph, Lee P. Shulman*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Late second trimester dilation and evacuation is a challenging subset of surgical abortion. Among the reasons for this is the degree of cervical dilation required to safely extricate fetal parts. Cervical dilation is traditionally achieved by placing multiple sets of osmotic dilators over two or more days prior to the evacuation procedure; however, there is interest in shortening cervical preparation time. The use of adjuvant mifepristone and misoprostol in conjunction with osmotic dilators has been studied for this purpose, and their use demonstrates that adequate cervical dilation can be achieved in less time than with dilators alone. We present a review of the current evidence surrounding adjunctive agents for cervical preparation, and contend that for women presenting for surgical abortion care above 19 weeks gestation, the use of adjunctive mifepristone and/or misoprostol should be strongly considered along with osmotic dilator insertion when cervical preparation in less than 24 h is needed.

Original languageEnglish (US)
Pages (from-to)1246-1251
Number of pages6
JournalAdvances in Therapy
Issue number6
StatePublished - Jun 1 2019


  • Cervical preparation
  • Dilation and evacuation
  • Induced abortion
  • Mifepristone
  • Misoprostol

ASJC Scopus subject areas

  • Pharmacology (medical)


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