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

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 four 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 eleven (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.