Cervical Preparation Before Dilation and Evacuation

NCT ID: NCT01751087

Last Updated: 2016-02-24

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-01-31

Study Completion Date

2014-06-30

Brief Summary

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The purpose of this research study is to compare three different ways of opening a woman's cervix before her second-trimester surgical abortion.

* Osmotic dilators: small rods that, when inserted into the cervix, gently expand to open the cervix
* Osmotic dilators plus mifepristone, a medicine that is swallowed
* Osmotic dilators plus misoprostol, a medicine that is placed between the cheek and gum

Hypotheses:

* adding buccal misoprostol 3 hours preoperatively will significantly improve dilation compared to laminaria alone, making procedures faster, easier and safer.
* adding oral mifepristone at the time of laminaria placement will confer a similar benefit.
* the efficacy of adjunctive misoprostol and mifepristone will be influenced by gestational age, with women later in gestation having increased efficacy from these agents.
* significantly more patients who receive adjunctive misoprostol or mifepristone will have adequate initial dilation, fewer will require manual dilation or additional cervical preparation and there will be fewer complications in these arms, although complication rates will be low and we will only be able to detect relatively large differences.
* patients will prefer to have the procedure done as quickly as possible with as little discomfort as possible, that cervical ripening with adjunctive misoprostol will be associated with more cramping than osmotic dilators alone and that mifepristone will be well tolerated and may not cause more cramping or other side effects than osmotic dilators alone.

Detailed Description

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Conditions

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Abortion, Induced

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Osmotic dilators + placebo (vit c) + placebo (vit B12)

Women will receive osmotic dilators on Day 1, oral placebo on Day 1, and buccal placebo on Day 2.

Group Type OTHER

Osmotic dilators

Intervention Type DEVICE

osmotic dilators on Day 1

placebo

Intervention Type OTHER

placebo for mifepristone, on day 1

placebo

Intervention Type OTHER

placebo for misoprostol, on day 2

Osmotic dilators + placebo (vit c) + misoprostol

Women will receive osmotic dilators on Day 1, oral placebo on Day 1, and buccal misoprostol 400 mcg on Day 2.

Group Type ACTIVE_COMPARATOR

misoprostol

Intervention Type DRUG

buccal misoprostol 400 mcg on Day 2

Osmotic dilators

Intervention Type DEVICE

osmotic dilators on Day 1

placebo

Intervention Type OTHER

placebo for mifepristone, on day 1

Osmotic dilators + mifepristone + placebo (vit B12)

Women will receive osmotic dilators on Day 1, oral mifepristone 200 mg on Day 1, and buccal placebo on Day 2.

Group Type ACTIVE_COMPARATOR

Mifepristone

Intervention Type OTHER

oral mifepristone 200 mg on Day 1.

Osmotic dilators

Intervention Type DEVICE

osmotic dilators on Day 1

placebo

Intervention Type OTHER

placebo for misoprostol, on day 2

Interventions

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Mifepristone

oral mifepristone 200 mg on Day 1.

Intervention Type OTHER

misoprostol

buccal misoprostol 400 mcg on Day 2

Intervention Type DRUG

Osmotic dilators

osmotic dilators on Day 1

Intervention Type DEVICE

placebo

placebo for mifepristone, on day 1

Intervention Type OTHER

placebo

placebo for misoprostol, on day 2

Intervention Type OTHER

Other Intervention Names

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Mifeprex Cytotec laminaria Dilapan-S vitamin C 500 mg vitamin B12 500 mcg

Eligibility Criteria

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Inclusion Criteria

* 18 years and older
* Able to give informed consent
* Medically eligible for outpatient second trimester pregnancy termination at the clinical site
* English-speaking or Spanish-speaking at sites with ability to obtain informed consent in Spanish

Exclusion Criteria

* Active bleeding (\>1 pad/hour) or hemodynamically unstable at enrollment
* Signs of chorioamnionitis or clinical infection at enrollment
* Signs of spontaneous labor or cervical insufficiency at enrollment
* Spontaneous intrauterine fetal demise
* Patient incarcerated
* Allergy to mifepristone or misoprostol
* Chronic steroid use or adrenal insufficiency
* Porphyria
* Inflammatory bowel disease requiring treatment
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Society of Family Planning

OTHER

Sponsor Role collaborator

Planned Parenthood League of Massachusetts

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Principal Investigator, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Planned Parenthood League of Massachusetts

Locations

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San Francisco General Hospital

San Francisco, California, United States

Site Status

Family Planning Associates

Chicago, Illinois, United States

Site Status

Brigham and Women's Hospital

Boston, Massachusetts, United States

Site Status

Boston Medical Center

Boston, Massachusetts, United States

Site Status

Planned Parenthood of New York City

New York, New York, United States

Site Status

Lovejoy Surgical Center

Portland, Oregon, United States

Site Status

Magee Women's Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Countries

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United States

References

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Goldberg AB, Fortin JA, Drey EA, Dean G, Lichtenberg ES, Bednarek PH, Chen BA, Dutton C, McKetta S, Maurer R, Winikoff B, Fitzmaurice GM. Cervical Preparation Before Dilation and Evacuation Using Adjunctive Misoprostol or Mifepristone Compared With Overnight Osmotic Dilators Alone: A Randomized Controlled Trial. Obstet Gynecol. 2015 Sep;126(3):599-609. doi: 10.1097/AOG.0000000000000977.

Reference Type DERIVED
PMID: 26196084 (View on PubMed)

Other Identifiers

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SFPRF6-MS

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

9-500-25.1

Identifier Type: -

Identifier Source: org_study_id

NCT01799928

Identifier Type: -

Identifier Source: nct_alias

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