Cervical Dilation in Second-Trimester Abortion

Hayes, Jennifer L.; Fox, Michelle C.

doi:10.1097/grf.0b013e3181a2b3cd

Cited by 17 publications

(15 citation statements)

References 14 publications

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“…In addition, adolescents have a higher risk for cervical laceration because they usually have small, physiologically immature cervices that are difficult to dilate [20-22]. Another significant problem with current cervical dilators is a lack of control over the rate of dilation – extremely rapid cervical dilation often leads to cervical laceration [23,24]. …”

Section: Discussionmentioning

confidence: 99%

Continuous controllable balloon dilation: a novel approach for cervix dilation

Arsenijevic

Vukcevic-Globarevic

Volarević

et al. 2012

Trials

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BackgroundCervical dilation using mechanical dilators is associated with various complications, such as uterine perforation, cervical laceration, infections and intraperitoneal hemorrhage. To achieve safe and painless cervical dilation, we constructed a new medical device to achieve confident mechanical cervical dilation: a continuous controllable balloon dilator (CCBD).MethodsControlled pumping of incompressible fluid into the CCBD increases the pressure and outer diameter of the CCBD, continuously dilating the cervical canal. The reliability of the CCBD was confirmed in vitro (testing for consistency and endurance, with no detected risk for breakage) and in vivo. A multi-center clinical study was conducted,with 120 pregnant women randomly assigned to one of three groups: Group I,control group, no dilation;Group II,mechanical dilation, Hegar dilator (HeD); and Group III,CCBD. The tissue material for histological evaluation was obtained from the endocervical mucosa before and after dilation using the HeD or CCBD.ResultsThe CCBD dilations were successful and had no complications in all 40 patients of Group III. The cervical tissue was markedly less damaged after CCBD dilation compared with HeD dilation (epithelium damage: 95% (HeD) vs. 45% (CCBD), P <0.001; basal membrane damage: 82.5% (HeD) vs. 27.5% (CCBD), P <0.001; stromal damage: 62.5% (HeD) vs. 37.5% (CCBD), P <0.01). Cervical hemorrhagia was observed in 90% of the patients after HeD dilation versus in 32.5% of the patients after CCBD dilation.ConclusionsThe CCBD should be used as a replacement for mechanical dilators to prevent uterine and cervical injury during cervical dilation.Trial registrationISRCTN54007498

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Section: Discussionmentioning

confidence: 99%

Continuous controllable balloon dilation: a novel approach for cervix dilation

Arsenijevic

Vukcevic-Globarevic

Volarević

et al. 2012

Trials

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“…Hayes and Fox8 have reported that Dilapan-S can be difficult to remove due to entrapment and fragmentation. This problem was not met in the Dilapan-S cohort we studied, which we attribute to our use of the dilators being in graded serial stages over 2 days along with the adjuvant use of high-dosage misoprostol.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Dilapan-S and laminaria for cervical priming before surgical pregnancy termination at 17–22 weeks' gestation

Chambers

Willcourt²,

Laver³

et al. 2011

IJWH

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Methods:A retrospective analysis of medical records of three consecutive cohorts of women. All cohorts received a digoxin feticide injection on Day 1. Two cohorts were treated with laminaria, cohort A of 151 women over 1–2 days and cohort B of 52 women over 1–3 days, and cohort C of 151 women was treated with Dilapan-S over 1–3 days.Results:Adequate cervical priming for dilatation and evacuation (D&E) on Day 2 was achieved in 98% of the Dilapan-S cohort and 56% of cohort A and 40% of the cohort B laminaria cohorts. Return to theater for D&E 3–4 hours after dilator insertion on Day 2 occurred in 62.3% of Dilapan-S cohort C and 9.3% of cohort A and 4% of cohort B laminaria cohorts (P = 0.001). A mean D&E theater time of 19 minutes for laminaria cohort A was reduced by 10.1% in the Dilapan-S cohort C (P = 0.02). The incidence of unscheduled overnight delivery outside the clinic was 0% for Dilapan-S and 1.3% for cohort A and 3.8% for cohort B laminaria cohorts (P = 0.14).Conclusion:Dilapan-S osmotic dilators are superior to laminaria in producing more cervical priming and dilatation in a shorter time. This enables 17–22 week D&E procedures to be carried out in fewer days and in shorter theater times. They also eliminate the risk of an unscheduled overnight delivery outside the clinic.

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“…The likelihood of cervical trauma can be greatly reduced by cervical preparation with Laminaria or pharmacotherapy prior to TOP [53–55]. Up to 3% of second trimester TOP procedures are complicated by cervical trauma [56].…”

Section: Short-term Harmsmentioning

confidence: 99%

Public Health Impact of Legal Termination of Pregnancy in the US: 40 Years Later

Thorp

2012

Scientifica

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During the 40 years since the US Supreme Court decision in Doe versus Wade and Doe versus Bolton, restrictions on termination of pregnancy (TOP) were overturned nationwide. The use of TOP was much wider than predicted and a substantial fraction of reproductive age women in the U.S. have had one or more TOPs and that widespread uptake makes the downstream impact of any possible harms have broad public health implications. While short-term harms do not appear to be excessive, from a public perspective longer term harm is conceiving, and clearly more study of particular relevance concerns the associations of TOP with subsequent preterm birth and mental health problems. Clearly more research is needed to quantify the magnitude of risk and accurately inform women with the crisis of unintended pregnancy considering TOP. The current US data-gathering mechanisms are inadequate for this important task.

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Cervical Dilation in Second-Trimester Abortion

Cited by 17 publications

References 14 publications

Continuous controllable balloon dilation: a novel approach for cervix dilation

Continuous controllable balloon dilation: a novel approach for cervix dilation

Comparison of Dilapan-S and laminaria for cervical priming before surgical pregnancy termination at 17–22 weeks' gestation

Public Health Impact of Legal Termination of Pregnancy in the US: 40 Years Later

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Cervical Dilation in Second-Trimester Abortion

Cited by 17 publications

References 14 publications

Continuous controllable balloon dilation: a novel approach for cervix dilation

Continuous controllable balloon dilation: a novel approach for cervix dilation

Comparison of Dilapan-S and laminaria for cervical priming before surgical pregnancy termination at 17&ndash;22 weeks' gestation

Public Health Impact of Legal Termination of Pregnancy in the US: 40 Years Later

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Comparison of Dilapan-S and laminaria for cervical priming before surgical pregnancy termination at 17–22 weeks' gestation