Cervical preparation and induction of fetal demise practices for dilation and evacuation abortion between 24- and 27-...

This study aimed to describe practices for cervical preparation and induction of fetal demise among physicians providing dilation and evacuation (D&E) for abortion between 24- and 27-weeks' gestation in ambulatory settings in the US.

Between June and September 2024, we recruited physicians from 14 ambulatory abortion facilities to complete an online survey. We conducted follow-up interviews with respondents as needed for clarification or additional information. We compared practices among providers using closed- and open-ended responses.

Among 18 respondents working at 12 facilities, most provided care throughout the gestational range and reported few limitations for obstetrical conditions (e.g. history of Cesarean section or placenta previa). It was common to place osmotic dilators the day before the D&E, use adjunctive misoprostol on the day of the D&E, and induce fetal demise on the first day of 2- or 3-day procedures. Variations across practices included number of procedure days, use of adjunctive mifepristone, medications for induction of fetal demise, timing of misoprostol, and techniques to address inadequate dilation. We described pain management and patient comfort techniques, as well as factors that influenced individualized care plans.

Later abortion providers report a wide range of practices and techniques which have been adapted from established second-trimester D&E practices to take care of patients with more advanced gestational durations. Physicians adjust their approach to accommodate the needs of the patient or clinical circumstances.

Physicians who provide abortion care at or above 24 weeks' gestation play a key role in ensuring abortion access throughout pregnancy. Documenting the diversity of current practices and techniques will support training new clinicians and those who wish to expand the gestational limits of their practice.