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Termination and Contraceptive Options for the Cardiac Patient
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
D&E generally requires cervical preparation (preoperative “ripening” and/or dilation of the cervix) in order to avoid trauma to the cervix. This can be achieved with osmotic dilators, prostaglandins, or mifepristone. Evacuation of the pregnancy is then performed with specialized forceps and suction. The difficulty of the procedure is commensurate with gestational age of the pregnancy and requires a skilled provider. Many women may not have access due to paucity of providers or state-specific legal restrictions [79].
Contraception and abortion
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
After 14 weeks, the surgical technique of choice is dilation and evacuation. In skilled hands, this procedure has a low complication rate and is highly acceptable to women. It is widely used in North America, but is less common in Europe. It is necessary to achieve good cervical dilation before the procedure (up to 20 mm) in order to remove larger fetal parts. This is achieved using one or a combination of either osmotic dilators (hygroscopic sticks placed in the cervix several hours preprocedure that absorb fluid from surrounding tissues, causing them to swell and bring about cervical dilation), or misoprostol (vaginal or sublingual) or mifepristone (oral). At surgery, the cervix is then further dilated using graduated dilators and the contents of the uterus removed by a combination of aspiration and extraction of fetal tissue using appropriate instruments; ultrasound is performed to confirm complete evacuation.
Contraception and termination of pregnancy
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Vacuum aspiration should be avoided at gestations below 7 weeks as the failure rate is higher. Conventional vacuum aspiration is an appropriate method at gestations of 7–15 weeks and can be carried out either under local or general anaesthesia [B]. For first-trimester suction termination, either electric or manual aspiration devices may be used, as both are effective and acceptable to women and clinicians. For gestations above 14 weeks, surgical abortion by D&E, preceded by cervical preparation, is safe and effective and should be undertaken by specialist practitioners who have a reasonable caseload to maintain their skills. Cervical preparation should be considered in all cases. The various regimens are: Up to 14 weeks: misoprostol 400 mg vaginally or sublingually 3 hours before surgery;14–18 weeks: osmotic dilators.
Moving preinduction cervical ripening to a lower acuity inpatient setting using the synthetic hygroscopic cervical dilator: a cost-consequence analysis for the United States
Published in Journal of Medical Economics, 2022
Sita J. Saunders, Jody L. Grisamore, Tess Wong, Rafael Torrejon Torres, Rhodri Saunders, Brett Einerson
In the comparison, patients received the SHCD (Dilapan-S, MEDICEM Technology, Czechia). Assessing all possible mechanical methods went beyond the scope of this work. The SHCD was considered to be more suitable than the Foley balloon for a lower acuity setting because (1) patients receiving the SHCD reported increased patient satisfaction outcomes, (2) the SHCD is FDA cleared for preinduction cervical ripening and the Foley balloon is not, (3) for the SHCD there is no protrusion from the introitus or need to keep it under tension, and (4) clinical safety and efficacy outcomes were reported to be non-inferior13. Other hygroscopic/osmotic dilators such as laminaria tents are primarily used during pregnancy termination5, whereas there is increasing evidence that the SHCD is safe for preinduction cervical ripening13,17,18. Please note that the predecessor of Dilapan-S was called Dilapan and was originally manufactured by Gynotech Inc., NJ until 1997. Early concerns of device fragmentation of Dilapan have been corrected and are not reported for Dilapan-S19.
Balloon Catheter for Cervical Priming before Operative Hysteroscopy in Young Women: A Pilot Study
Published in Journal of Investigative Surgery, 2020
Francesca Falcone, Gennaro Raimondo, Michael Stark, Salvatore Dessole, Marco Torella, Ivano Raimondo
In the setting of cervical priming before operative hysteroscopy, misoprostol and natural osmotic dilators (laminaria) have been the best studied agents so far. Data from the literature indicate that both misoprostol and osmotic dilators before resectoscopic procedures add significant benefits in terms of baseline cervical dilatation and ease of additional dilatation, reducing the risk of complications [2–5]. The ideal misoprostol dose and route of administration, however, are not yet standardized. Furthermore, the possible benefits of misoprostol need to be weighed against its common side effects (abdominal pain, nausea, diarrhea, vaginal bleeding, increased body temperature). Overall, laminaria seems to be more effective than misoprostol in achieving a satisfactory cervical priming before operative hysteroscopy with fewer adverse effects [2]. Laminaria, however, has the disadvantage of requiring insertion and retention for one to two days.
Risk of preterm delivery after medically indicated termination of pregnancy with induced vaginal delivery: a case-control study
Published in Journal of Obstetrics and Gynaecology, 2022
Jean-Daniel Hini, Gilles Kayem, Thibaud Quibel, Paul Berveiller, Celine De Carne Carnavale, Pierre Delorme
TOP methods vary according to gestational age. Before 14 weeks, intrauterine aspiration (surgical TOP) can be performed. After 14 weeks, or if a histological foetal analysis is indicated and desired by the couple, TOP is performed nonsurgically in the delivery room. Delivery can then be induced by mechanical (osmotic dilators such as Dilapans®, laminaria, or balloon catheters) or pharmacological (misoprostol) methods.