Abstract
Objective
Document the effectiveness and safety of Foley balloon catheter and misoprostol use
for cervical preparation before a same-day dilation and evacuation (D&E).
Study design
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.
Results
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.
Conclusion
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.
Implications
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.
Keywords
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References
- Society of Family Planning clinical recommendations: cervical preparation for dilation and evacuation at 20-24 weeks’ gestation.Contraception. 2020; 101: 186-192
- The Safety and Quality of Abortion Care in the United States.The National Academies Press, 2018 (Accessed June 30, 2020)
- Cervical preparation for second-trimester surgical abortion prior to 20 weeks’ gestation.Contraception. 2014; 89: 75-84
- Comparison of the Foley catheter and dinoprostone pessary for cervical preparation before second trimester abortion.Br J Obstet Gynaecol. 1989; 96: 1432-1434
- Standardizing the Classification of Abortion Incidents: The Procedural Abortion Incident Reporting and Surveillance (PAIRS) Framework.Contraception. 2017; 96: 1-13
State Facts About Abortion: Alabama. Guttmacher Institute. doi:10.1363/2019.30760
- Estimated versus measured blood loss during dilation and evacuation: an observational study.Contraception. 2018; 97: 451-455
- Intracervical Foley balloon catheter for cervical ripening and labor induction: a review.Semin Perinatol. 2015; 39: 441-443
Article info
Publication history
Published online: June 23, 2021
Accepted:
June 17,
2021
Received in revised form:
June 17,
2021
Received:
September 13,
2020
Footnotes
Preliminary findings from this work were presented at the National Abortion Federation's annual meeting in Chicago in 2019 and the Society of Family Planning's annual meeting in Los Angeles in 2019.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
