Hygroscopic dilator (Dilapan-STM) and misoprostol combination for the early first-trimester termination of pregnancy: a pilot study

Background and methodology Uptake of the mifepristone/ misoprostol combination to induce early medical abortion in England and Wales has been slow. Women’s concern that early medical abortion is painful may be a contributory factor. This pilot study evaluated the pain experienced by women when Dilapan-STM, a synthetic hygroscopic dilator (polyacrylonitrile) is used instead of mifepristone as cervical preparation prior to administration of a misoprostol. Results Of 25 patients completing the trial, 17 aborted in 45 ©FSRH J Fam Plann Reprod Health Care 2009: 35(1) Introduction Medical termination of pregnancy (TOP) using a combination of anti-progesterone (mifepristone) and a prostaglandin has been slow to gain popularity in England and Wales, though recently there has been an increase in uptake. The experience in Scotland where uptake has been better suggests that increasing provision and promotion of the method has a positive impact. A significant number of women experience pain during medical TOP,1,2 which may deter some women from opting for this procedure. Mifepristone is an anti-progestogenic steroid that sensitises the myometrium to prostaglandin-induced contractions and ripens the cervix. Dilapan-STM (Figure 1), a hygroscopic mechanical dilator (Gel-Med International, spol. sr.o., Karlovarska 20, Kamenne Zehrovice, CZ 273 01, Czech Republic/PO Box 65, St Albans, Herts AL3 8EQ, UK) may be used to prepare the cervix before TOP. This device is used routinely prior to second-trimester dilatation and evacuation at King’s College Hospital, London, UK. Inserted 4–24 hours prior to TOP, it absorbs fluid and painlessly dilates the cervix. The hypothesis was that prior cervical preparation with Dilapan-S followed by misoprostol would be more effective and therefore less painful than the mifepristone/misoprostol combination. There are no reported studies comparing the effect of mifepristone and Dilapan-S on the cervix. As a first step the pain experienced by women during abortion using the Dilapan-S/misoprostol combination was assessed. There are no reports in the literature of this combination being used to cause medical abortion in pregnancies of less than 9 weeks. This communication reports a pilot study that could be taken forward to a randomised study to compare the use of Dilapan-S/misoprostol with mifepristone/misoprostol in the induction of abortion. Hygroscopic dilator (Dilapan-STM) and misoprostol combination for the early first-trimester termination of pregnancy: a pilot study Mannampallil I Samuel, John H Parsons SHORT COMMUNICATION Department of Sexual Health, King’s College Hospital NHS