Excessive bleeding after dilation and evacuation (D&E) requiring interventions is common,
occurring in approximately 30% of cases at one large abortion-providing clinic. Uterotonic
prophylaxis at the time of D&E, particularly with methylergonovine maleate (MM), is a common
practice among D&E providers despite nearly no evidence for its efficacy. Finding ways to
decrease excessive bleeding after D&E has the potential both to improve patient safety and to
reduce costs of provider-initiated interventions. The investigators propose a randomized,
controlled trial to investigate the efficacy of MM prophylaxis versus placebo in decreasing
excessive bleeding measured by a composite outcome among women undergoing D&E at 20 to 24
weeks.