Misoprostol as an adjunct to overnight osmotic dilators prior to second trimester dilation and evacuation: A systematic review and meta-analysis

Cahill EP, Henkel A, Shaw JG, Shaw KA

Dec 2019


To understand effect of adjunct misoprostol on cervical preparation with overnight osmotic dilators for dilation and evacuation after 16 weeks gestation.


We searched on-line reference databases using search terms for second trimester, abortion, misoprostol, and dilators. Randomized controlled trials of cervical preparation for second trimester D&E using overnight osmotic dilators comparing adjunct misoprostol to placebo were included. Weighted mean with standard deviation (SD) and pooled binary outcomes were compared.


Among 84 articles identified, three met inclusion criteria (n = 457 subjects) adjunct misoprostol did not significantly decrease mean procedure times (8.5 ± 4.6 vs 9.6 ± 5.8 min, p = 0.78) or manual dilation (18% vs 28%, p = 0.23) when compared to placebo. There was no difference in total complications (p = 0.61), major complications (p = 0.44), or cervical lacerations (p = 0.87).


Current limited evidence suggests adjunct misoprostol with osmotic dilators after 16 weeks does not affect procedure time or need for manual dilation.


Further research is needed to determine the effect of adjunct misoprostol on major complications and blood loss.