Foley catheter and misoprostol for cervical preparation for second-trimester surgical abortion

Document the effectiveness and safety of Foley balloon catheter and misoprostol use for cervical preparation before a same-day dilation and evacuation (D&E).

We conducted a retrospective medical records review of adult patients with viable pregnancies at 18 weeks 0 days to 21 weeks 6 days gestation who received a same-day D&E at an Alabama clinic using a 30-cc Foley balloon catheter and misoprostol for cervical preparation from January 2016 through December 2017. Patients received misoprostol 800 mcg buccally at the time of Foley placement and then every 4 hours until the physician deemed that dilation/effacement was adequate to proceed with a D&E. We extracted patient demographics, pregnancy and medical history, and preoperative, intraoperative, and postoperative data. We primarily evaluated effectiveness (D&E completion within one procedure day). Our secondary outcomes included safety, time between misoprostol and procedure start time, length of D&E, recovery time, and number of doses of misoprostol provided.

Two hundred and ninety patient charts met our review criteria - all of whom had a complete abortion in one day. Only one safety incident, a cervical laceration, occurred (0.3% of all procedures). The median time between Foley placement and first misoprostol dose and the procedure start was 7.2 hours (2.9-12.6 hours; interquartile range [IQR] 6.2-8.4 hours); median procedure length was 12 minutes (2-40 minutes; IQR 10-15 minutes); and median recovery time 14 minutes (4-89 minutes; IQR 14-16 minutes). Most patients needed two doses of misoprostol (n = 258, 89%), and 11 (4%) needed three doses; 21 (7%) patients needed one dose of misoprostol.

Patients in the mid-second trimester can effectively and safely undergo cervical preparation with a Foley balloon catheter and misoprostol to facilitate completion of same-day D&E.

Foley balloon catheter use with misoprostol for cervical preparation for second-trimester abortion (the Robinson Foley protocol) is effective and safe and can be completed in one day when used by an experienced physician.