Preoperative Cervical Dilatation: A Trial of Laminaria Tents and Prostaglandin F_α2 Gel

Abstract

Surgical damage to the cervix in patients undergoing termination of pregnancy may be responsible for serious complications in subsequent pregnancies. Sixty nulliparous women undergoing first trimester termination of pregnancy were randomly allocated to 3 treatment groups, one using laminaria tents preoperatively, one using intracervical PGF2 alpha gel preoperatively and one using no pretreatment. Results showed clear benefits in the laminaria group, in terms of achieving preoperative cervical dilatation and ease of further operative dilatation. Laminaria tents were superior to PGF2 alpha gel which was, in turn, superior to no pretreatment. There were no differences in blood loss or postoperative complications among the 3 groups. Laminaria tents provide a cheap, effective and safe method of reducing the risk of cervical damage in women undergoing surgical termination of pregnancy.

Cervical dilation before first-trimester surgical abortion (< 14 weeks' gestation)

“…Other studies hypothesized that passive dilation of the cervix with prostaglandins or similar agents might avert uterine perforation and cervical laceration through a reduction in the force required for dilation [27,28]. In addition, older medical literature reflects a concern that forceful cervical dilation may cause permanent damage to the cervical tissue, leading to poor reproductive outcomes [24,[29][30][31][32][33][34]. Cervical priming was therefore recommended to prevent such long-term complications as spontaneous abortion, cervical insufficiency and preterm delivery.…”

Pregnancy Outcomes After Laminaria Placement and Second-Trimester Removal

“…(Obstet Gynecol 2009;114:456-8) M ultiple reports describe efficacious use osmotic dilators to achieve safe outcomes for surgical pregnancy termination. [1][2][3][4][5] Although there are data suggesting that laminaria placed in previous pregnancies do not complicate future pregnancies, 6,7 very little is known about risks for continued pregnancies after laminaria have been inserted and removed when a patient changes her mind regarding the procedure. To date, there are two published case series describing obstetric outcomes after removal of laminaria tents inserted for intended terminations.…”