Inclusion Criteria:  presenting to clinic for second trimester abortion at 18 to 23 weeks and 6 days gestation confirmed by ultrasound able to provide informed consent and comply with study protocol English or Spanish-speaking candidate for outpatient cervical preparation  Exclusion Criteria:  Anyone with an allergy to misoprostol, mifepristone or any study medication premature rupture of membranes intrauterine fetal demise placenta previa suspected abnormal placentation evidence of infection at the time of enrollment