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Preparing the cervix

(neck of the womb)

Cervical preparation is given before surgical abortion at all gestations.

If you have been asked to attend the clinic so that your cervix can be prepared the day before your treatment, you should expect to be at the clinic for up to 3 hours.

The cervix (neck of the womb) can be prepared for treatment with the medications mifepristone, misoprostol, and absorbent dilators called Dilapan. You may need only one of these medications or you may need more. We will fully explain which preparation you need and when this will occur.

Mifepristone and misoprostol tablets soften the cervix, making it easier to dilate (open).

Mifepristone is a pill that you swallow. You may be given a mifepristone tablet to take at home, the tablet could be mailed to you in the post, or you may be asked to take it in the clinic. Mifepristone can cause cramping, vaginal bleeding, or nausea. If you vomit within an hour of taking mifepristone, please let the clinic know when you arrive for your treatment.

Rarely women may go on to miscarry their pregnancy because of taking mifepristone. This risk increases if mifepristone is used together with other methods of cervical preparation (Dilapan) or you have had feticide as part of your treatment, but remains an uncommon risk. Heavy bleeding or labour pains or the waters breaking can be signs of miscarriage. If any of these occur while you are at home, call the clinic or Aftercare Line on 0300 333 68 28 (or +44 1789 508 210) for advice.

Misoprostol tablets are either placed in your vagina or under your tongue in clinic before the procedure. Refer to the table opposite for the full list of side effects.

Dilapan are matchstick-sized rods that are inserted into the cervix before surgery. They swell to gently open the cervix. Insertion takes place in the clinic and takes just a few minutes. We may use injectable or sprayable local anaesthetic for this procedure. If your treatment is planned over 2 days, you will go home after they are placed. As the Dilapan expands it can cause cramping or very light bleeding and very rarely your waters can break and you may go on to miscarry. Sometimes the Dilapan may fall out. You will be given extra information about pain control and what to do if you start labour or your waters break.

If you experience problems after the Dilapan has been inserted, call the clinic or Aftercare Line on 0300 333 68 28 (or +44 1789 508 210) for advice.

How Dilaplan swells in the cervix

 

We may recommend the standard, alternative or special cervical preparation, whichever is most suitable for you.


Side effects, risks and complications

Mifepristone

Misoprostol

Dilapan

Very common (1/1 to 1/10):

  • lower abdominal cramping
  • vaginal bleeding/spotting

Common (1/10 to 1/100):

  • nausea/vomiting

Uncommon (1/100 to 1/1000):

  • may expel pregnancy before surgery

 
Very common (1/1 to 1/10):

  • lower abdominal cramping
  • bleeding
  • nausea/vomiting
  • headache
  • fever/chills
  • dizziness
  • tiredness
  • diarrhoea

 Uncommon (1/100 to 1/1000):

  • may expel pregnancy before surgery

Very common (1/1 to 1/10):

  • pain during insertion
  • cramping and mild bleeding as the dilators swell

 Uncommon (1/100 to 1/1000):

  • rupture of membranes
  • onset of labour
  • may expel pregnancy before surgery