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Related Experiment Video

Updated: Jun 10, 2026

External Cephalic Version: Is it an Effective and Safe Procedure?

External Cephalic Version: Is it an Effective and Safe Procedure?

Published on: June 6, 2020

Cervical preparation for second trimester dilation and evacuation.

Sara J Newmann¹, Andrea Dalve-Endres, Justin T Diedrich

¹Obstetrics and Gynecology and Reproductive Sciences, University of California, San Francisco General Hospital, 1001 Potrero Avenue Ward 6D, San Francisco, California, USA, CA 94110.

The Cochrane Database of Systematic Reviews

|August 6, 2010

Summary

Osmotic dilators are more effective for cervical preparation before second-trimester abortion (D&E) than prostaglandins, offering better dilation without increasing procedure time or complications. Same-day procedures are safe in early pregnancy.

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Area of Science:

Medical research
Gynecology
Reproductive health

Background:

Second-trimester abortions represent 10-15% of global abortions.
Dilation and evacuation (D&E) is the preferred method for second-trimester abortion.
Cervical preparation is crucial for D&E safety and efficacy, yet optimal methods remain debated.

Purpose of the Study:

To evaluate and compare cervical preparation methods for second-trimester surgical abortion.
Assess differences in procedure time, dilation, complications, and patient/provider satisfaction.
Identify superior methods for optimizing D&E procedures.

Main Methods:

Systematic review of randomized controlled trials (RCTs).
Included studies compared various cervical preparation agents (osmotic, mechanical, medical).
Data analysis included mean differences and Peto Odds Ratios for key outcomes.

Main Results:

Osmotic dilators provided superior cervical dilation compared to prostaglandins.
Adding prostaglandins to osmotic dilators did not significantly improve dilation or reduce procedure time.
Two-day preparation showed no advantage over one-day preparation below 19 weeks gestation.

Conclusions:

Cervical preparation using osmotic dilators and/or misoprostol is safe and effective for second-trimester D&E.
Osmotic dilators offer better dilation than prostaglandins without impacting procedure time or complication rates.
Same-day procedures are viable in early second-trimester, with further research needed for later gestations.