RESUMO
OBJECTIVES: To compare procedure times following same-day cervical preparation using misoprostol 400â¯mcg alone or misoprostol 400â¯mcg plus hygroscopic dilators for dilation and evacuation (D&E) before 20â¯weeks gestation and to compare side effects of buccal and vaginal misoprostol administration. STUDY DESIGN: We randomized women undergoing D&E at 14â¯weeks 0â¯days-19â¯weeks 6â¯days gestation to receive (1) hygroscopic dilators or not and (2) buccal or vaginal misoprostol using a 2â¯×â¯2 factorial design. We assessed two primary outcomes: (1) total procedure time, defined as time to insert hygroscopic dilators plus D&E time, and (2) side effects of misoprostol 4-6â¯h after initiation of cervical preparation using a 5-point Likert scale assessing nausea, emesis, diarrhea, chills and cramps. RESULTS: We randomized 163 women and 161 completed the study. We completed all procedures in one day. Mean total procedure time was 14.0 and 10.8â¯min. with and without hygroscopic dilators (difference 3.2â¯minutes, 95% CI 1.7, 4.6). Mean D&E procedure time was 0.7 (95% CI -0.8, 2.1)â¯min longer without hygroscopic dilators. Initial cervical dilation was 15.6 and 11.7â¯mm with and without hygroscopic dilators (difference 3.9â¯mm, 95% CI 3.1, 4.8). Participants receiving buccal misoprostol reported less chills (1.9) than women receiving vaginal misoprostol (2.3), pâ¯=â¯0.04. CONCLUSIONS: Hygroscopic dilators with misoprostol requires more time and increases cervical dilation without shortening D&E time when used for cervical preparation 4-6â¯h prior to D&E before 20â¯weeks. Women receiving vaginal misoprostol may have more chills compared to buccal misoprostol. IMPLICATIONS: Adding hygroscopic dilators to misoprostol for same day D&E procedures at less than 20 weeks gestation increases total intervention time without reducing D&E time and is less favored by patients. Clinical judgment requires balancing relative effectiveness with patient preference. Further studies should evaluate the side effect profile of vaginal misoprostol.