Objective: In France, terminations of pregnancy (TOP) for medical reasons beyond the second trimester use mifepristone and misoprostol. We sought to determine the effectiveness of Dilapan-S®, an osmotic cervical dilator, in shortening the induction-to-delivery interval (IDI). Materials and Methods: This retrospective study of TOP in 2010-2012 compared the results from 2 hospitals with different TOP protocols starting at 16 weeks' gestation, one (164 women) with and one (106) without Dilapan-S®. The principal endpoint was the IDI. Results were analyzed according to 2 definitions of induction onset: definition 1, first dose of misoprostol in both centers, or definition 2, dilator placement if used, and otherwise first dose of misoprostol. Results: With definition 1, the IDI was shorter with dilators (5 h 48 min vs. 10 h 18 min, p < 0.001); the rates of uterine evacuation within 12 and 24 h were higher (94.5 and 100 vs. 68.9 and 91.5%, p < 0.001), and the time between first misoprostol dose and amniotomy was shorter (0 h 47 min vs. 4 h 30 min, p < 0.001). Under definition 2, the IDI was longer with dilators (18 h 24 min vs. 10 h 18 min, p < 0.001), but the rate of evacuation within 24 h did not differ significantly. Conclusion: Dilapan-S® acts on cervical ripening and dilatation, thereby allowing early amniotomy. Assessing potential side effects and women's satisfaction requires prospective trials.

Houfflin-Debarge V, Vaast P: Interruption médicale de grossesse. Processus décisionnel et prise en charge. Extrait des Mises à jour en Gynécologie et Obstétrique, Tome XXXII, publié le 3/12/2008, p 41.
Hern WM: Laminaria versus Dilapan osmotic cervical dilators for outpatient dilation and evacuation abortion: randomized cohort comparison of 1001 patients. Am J Obstet Gynecol 1994;171:1324-1328.
Darney PD: Preparation of the cervix: hydrophilic and prostaglandin dilators. Clin Obstet Gynaecol 1986;13:43-51.
Perrotte F, Mirlesse V, De Vigan C, Kieffer F, Meunier E, Daffos F: Interruption médicale de grossesse pour anomalie foetale: le point de vue des patientes. J Gynecol Obstet Biol Reprod 2000;29:185-191.
Burnett MA, Corbett CA, Gertenstein RJ: A randomized trial of laminaria tents versus vaginal misoprostol for cervical ripening in first trimester surgical abortion. J Obstet Gynaecol Can 2005;27:38-42.
MacIsaac L, Grossman D, Balistreri E, Darney P: A randomized controlled trial of laminaria, oral misoprostol, and vaginal misoprostol before abortion. Obstet Gynecol 1999;93:766-770.
Schaub B: Les protocoles en vigueur dans les CPDPN à l'heure de la mise en question du Cytotec hors AMM, présentation orale au Club de Médecine Foetale, 2013. Accessible at www.cpdpn.fr.
Dodd JM, Crowther CA: Misoprostol for induction of labour to terminate pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death. Cochrane Database Syst Rev 2010;4: CD004901.
Brouns JF, van Wely M, Burger MP, van Wijngaarden WJ: Comparison of two dose regimens of misoprostol for second-trimester pregnancy termination. Contraception 2010;82:266-275.
Mandelbrot L, Girard G: Aspects techniques des interruptions médicales de grossesse. Extrait des Mises à jour en Gynécologie et Obstétrique, Tome XXXII, publié le 3/12/2008, p 7.
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