Mifepristone prior to osmotic dilators for dilation and evac
The aim was to evaluate mifepristone impact on osmotic dilator placement and procedural outcomes when given 18-24 hours before dilator placement for dilation and evacuation (D&E) at 18 weeks 0 days to 23 weeks 6 days gestation.

Researchers performed a randomized, double-blind, placebo-controlled trial, enrolling participants undergoing osmotic dilator placement for a planned, next-day D&E. Participants took mifepristone 200 mg or placebo orally 18-24 hours before dilator placement. They used a gestational age-based protocol for a minimum number of dilators.

Of the planned 66 participants, they enrolled 44, and 41 completed the study. They placed two or more additional dilators compared to standard in seven (36.8%) and three (13.6%) participants after mifepristone and placebo, respectively. They measured greater median initial cervical dilation in the mifepristone compared to the placebo group. The surgeon's perception of the procedure being “easy” and complication rate did not differ.

The underpowered study did not demonstrate a difference in cervical dilator placement, but mifepristone 18-24 hours prior to dilators increases cervical dilation without increasing complications.

Source: https://doi.org/10.1016/j.contraception.2021.08.013