Version May 2024
| Weeks | Hospital-based academic practice A | Hospital-based academic practice B | Freestanding nonprofit clinic | Freestanding private clinic |
| <12 | Mechanical dilation alone | Mechanical dilation alone | Mechanical dilation alone | Mechanical dilation alone |
| 12 | Nulliparous: Misoprostol 400 mcg buccal 2 to 3 hours | Misoprostol 400 mcg 2 to 4 hours OR 1 Dilapan overnight | Nulliparous: Misoprostol 400 mcg buccal 2 to 3 hours | Nulliparous: Misoprostol 400 mcg intravaginal 2 to 3 hours Multiparous: Misoprostol 400 mcg intravaginal 1 to 3 hours |
| 13 | Misoprostol 400 mcg buccal 2 to 3 hours | Misoprostol 400 mcg 3 to 4 hours OR 1 Dilapan overnight | Nulliparous: Misoprostol 400 mcg buccal 2 to 3 hours | Misoprostol 400 mcg intravaginal 2 to 3 hours |
| 14 | Misoprostol 400 mcg buccal 2 to 3 hours | Misoprostol 400 mcg 3 to 4 hours OR 2 Dilapan overnight | Misoprostol 400 mcg buccal 2 to 3 hours | Misoprostol 400 mcg intravaginal 2 to 3 hours |
| 15 | Misoprostol 400 mcg buccal 2 to 3 hours | Misoprostol 400 mcg 3 to 4 hours OR 2 Dilapan overnight | Misoprostol 400 mcg buccal 2 to 3 hours | Misoprostol 400 mcg intravaginal 2 to 4 hours |
| 16 | Same-day: 2 to 4 Dilapan, 1 laminaria¶ Day 1: Minimum 2 Dilapan, 1 laminaria Day 2: D&E | Misoprostol 400 mcg 3 to 4 hours OR 3 Dilapan overnight◊ | 1 to 2 Dilapan and misoprostol 400 mcg buccal 2 to 3 hours | Misoprostol 400 mcg intravaginal 2 to 4 hours |
| 17 | Same-day: 3 to 5 Dilapan, 1 laminaria¶ Day 1: Minimum 2 Dilapan, 1 laminaria Day 2: D&E | Misoprostol 400 mcg 3 to 4 hours OR 3 Dilapan overnight◊ | 1 to 2 Dilapan and misoprostol 400 mcg buccal 3 to 4 | 4 Dilapan§ with misoprostol 400 mcg intravaginal 4 to 5 hours |
| 18 | Day 1: Minimum 3 Dilapan, 1 laminaria Day 2: D&E | Day 1: 4 Dilapan◊ Day 2: D&E | Day 1: 1 to 2 Dilapan and mifepristone Day 2: Misoprostol 800 mcg rectally prior to dilator removal; D&E | 4 Dilapan§ with misoprostol 400 mcg intravaginal 4 to 5 hours |
| 19 | Day 1: Minimum 4 Dilapan, 1 laminariaΔ Day 2: D&E | Day 1: 4 Dilapan◊ Day 2: D&E | Day 1: 1 to 2 Dilapan and mifepristone Day 2: Misoprostol 800 mcg rectally prior to dilator removal; D&E | 4 Dilapan§ with misoprostol 400 mcg intravaginal 4 to 5 hours |
| 20 | Day 1: Minimum 5 Dilapan, 1 laminariaΔ Day 2: D&E | Day 1: 5 Dilapan◊ Day 2: D&E | Day 1: 3 to 4 Dilapan and mifepristone Day 2: Misoprostol 800 mcg rectally prior to dilator removal; D&E | 4 Dilapan§ with misoprostol 400 mcg intravaginal 4 to 5 hours |
| 21 | Day 1: Minimum 6 Dilapan, 1 laminariaΔ Day 2: D&E | Day 1: 6 Dilapan◊ Day 2: D&E | Day 1: 4 to 5 Dilapan and mifepristone Day 2: Misoprostol 800 mcg rectally prior to dilator removal; D&E | Day 1: Mifepristone Day 2: Misoprostol 400 mcg intravaginal 2 to 4 hours; D&E |
| 22 | Day 1: Minimum 7 Dilapan, 1 laminariaΔ Day 2: D&E | Day 1: 7 Dilapan and mifepristone Day 2: D&E | Day 1: 5 to 6 Dilapan and mifepristone Day 2: Misoprostol 800 mcg rectally prior to dilator removal; D&E | Day 1: Mifepristone Day 2: Misoprostol 400 mcg intravaginal 2 to 4 hours; D&E |
| 23 | Day 1: Minimum 8 Dilapan, 1 laminaria, mifepristone Day 2: D&E | Day 1: 8 Dilapan and mifepristone Day 2: D&E | Day 1: 6 to 8 Dilapan and mifepristone Day 2: Misoprostol 800 mcg rectally prior to dilator removal; D&E | Day 1: 6 to 8 Dilapan§, intracardiac lidocaine, mifepristone Day 2: Misoprostol 400 mcg intravaginal 1 to 3 hours; D&E |
| 24 | Day 1: Minimum 9 Dilapan, 1 laminaria, mifepristone Day 2: D&E | Day 1: 8 to 10 Dilapan§, intracardiac lidocaine, mifepristone Day 2: Misoprostol 400 mcg intravaginal 1 to 3 hours; D&E |
D&E: dilation and evacuation.
* All instances of Dilapan refer to Dilapan-S.
¶ Same-day procedures require dilators for at least 4 hours. 400 mcg buccal misoprostol is also given if insufficient dilators are placed.
Δ Mifepristone added for adolescents, patients with a history of cervical surgery, or if the minimum number of dilators is not placed.
◊ Mifepristone added if insufficient dilators placed.
§ Gabapentin 300 mg administered 30 minutes prior to dilator insertion.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
