Approximately 30% of females will have an abortion by age 45 years; most of these occur in an outpatient setting. [1]In2013, first-trimester aspiration procedures were the most common therapeutic intervention accounting for 74% of abortions. [1]However, more recent data from high-income countries indicate that medical abortions account for approximately half of all abortions, and about 90% of all abortions were completed before 13 weeks. [2] Hemorrhage is extremely rare in nonpregnant patients undergoing D&C. The operator should consider uterine perforation or cervical injury as the most likely cause in this setting and manage it appropriately. Hemorrhage is more common in a pregnant patient undergoing D&C, and the risk increases with increasing gestational age and in the postpartum period. Retained products of conception, uterine atony, abnormal placentation, and injury to the cervix or uterus can potentially cause significant hemorrhage in pregnant or postpartum patients undergoing D&C. [13]Management of complications should be specific to the underlying etiology. A D&C may be performed in the evaluation of abnormal uterine bleeding. However, with the advent of aspiration devices for endometrial biopsy and advances in ultrasound technology, the D&C is rarely the first step in the evaluation. D&C may also be used to manage abnormal uterine bleeding refractory to medical therapy. [3] Diagnosis and treatment of CI: all 10 patients had a previous history of typical painless cervical dilation during the second trimester before surgery, and in 6 patients, the No. 7 Hegar dilator could pass through the internal cervical os before surgery without resistance. In the other 4 patients, the cervical dilator could not be inserted before surgery due to adhesions of the cervical canal and the lower uterine segment; the diagnoses of these patients were further confirmed 3 months after the HA when the No. 7 Hegar dilator was able to pass through the internal cervical os without resistance. There were 9 patients who underwent pre-pregnancy laparoscopic cervical cerclage after HA. The remaining 1 patient underwent laparoscopic cervical cerclage prior second HA, as the cervix was too loose to retain and be treated with an IUD or distended Foley’s catheter balloon ( Figures 1,2 ​ 1,2) ) which essentially prevent postoperative adhesion reformation. Ten patients underwent laparoscopic cervical cerclage with an intraoperative blood loss of 10–50 mL, with an average blood loss of 27±16.16 mL. Pregnancy outcomes: the mean delivery gestational age was 37.2±1.17 weeks (range, 35 to 38). One patient underwent cesarean section due to preterm labor at 35 weeks of pregnancy without premature rupture of membranes; the remaining 5 patients underwent elective cesarean sections at 37 to 38 weeks. six patients who underwent cesarean section experienced no serious surgical complications. The intraoperative blood loss was 100–800 mL, with an average of 283±263 mL.

Anal dilation isn’t something you want to rush, so choose a time when you’re sure you can relax and go slow without interruptions. Help yourself unwind A bivalve or weighted speculum is placed in the vagina. If local anesthesia is used, then the cervix and lower uterine segment should be injected. Most commonly, 1% lidocaine is adequate. A tenaculum is used to grasp the anterior lip of the cervix and pull towards the introitus with the non-dominant hand. The traction will stabilize the uterus and reduce the cervicouterine angle to decrease the risk of uterine perforation. Routine use of uterine sound for cavity length does not benefit the procedure unless the uterus was not palpable on the initial bimanual examination. First, try not to freak out. Stop what you’re doing, remove the dilator very gently, and head to the mirror to assess the situation. Curettes may be metal or plastic. The diagnostic D&C is typically performed using a sharp metal curette (Figure 5). Metal currettes have a long malleable handle with an open teardrop shape at the tip. These curettes are available in various sizes and are measured by the largest diameter at the tip. A toothed curette is sometimes used in postmenopausal patients for aggressive tissue sampling of the endometrium.

Translation

Preparation is key anytime you’re inserting anything in your butt. It can make or break your experience… and your anus. Uterine sounding may be performed prior to embryo transfer to determine the uterine depth and how easily an embryo transfer catheter can be passed through the cervix. In this case, it may also be called a trial transfer. [1]

Not all materials are safe for your special place so you’ll definitely want to be mindful of what your device is made of. According to the American College of Obstetricians and Gynecologists (ACOG) guidelines ( 2), the diagnostic criteria for simple CI are based on 3 aspects: medical history, ultrasound indicators, and a tentative diagnosis during the nonpregnancy period. Among them, the medical history is the most important for the diagnosis of CI, and a history of miscarriage in the second trimester or premature birth caused by repeated painless cervical dilatation is the direct basis for the diagnosis of CI. At the same time, a cervical canal width >0.6 cm at the internal cervical os under ultrasound examination can also assist in the diagnosis. Other diagnostic modalities of CI include: hysterosalpingography (HSG) and imaging of balloon traction on the cervix radiographically, assessment of the patulous cervix with Hegar or Pratt dilators, balloon elastance test, and graduated cervical dilators which are used to calculate the cervical resistance index based on the functional anatomy of the internal os in the non-pregnant state. In this study, CI was diagnosed upon easy passage of the No. 7 Hegar dilator through the intracervical canal. We’re not saying you need to risk bankruptcy or anything, but choosing a quality dilator is important. HL Dilators TM are lengthier compared to the Hegar dilators. This additional length is advantageous, especially when a subcoronal approach is preferred for penile prosthesis implantation. Due to the 25 cm length of the HL Dilators TM, even from a subcoronal corporotomy, the surgeon can dilate the corpus cavernosum down to the crus of penis in one single move and reliably measure the corpus. In most cases, the distance from the subcoronal corporotomy to the crus of penis is longer than the Hegar dilator’s length [ 5].Length isn’t a factor if your goal is dilation. However, you’ll want to be sure anything you use has a flared base. You should never insert anything into your anus that doesn’t have a flared base as it could become lodged and lead to a medical emergency. Material The rate is 0.6 per 100,000 legally-performed induced abortions. To put this in perspective, the risk of death associated with childbirth is 14 times this rate. However, the risk of morbidity and mortality increases with increasing gestational age. [13] Chemical ripening agents are prostaglandin analogs or progesterone antagonists, which soften or prime the cervix. [8]Misoprostol, a prostaglandin analog, is the most common vaginally-administered medication. Misoprostol is a safe and effective form of cervical preparation and can be administered on the same day as the procedure. [9] [10]The progesterone antagonist, mifepristone, is as effective as misoprostol; however, its high cost and limited availability prohibit routine use. The Society of Family Planning does not recommend any cervical preparation for first-trimester abortions unless the patient is at an increased risk of complications such as cervical lacerations, inadequate cervical dilation, or uterine perforation. [8]Cervical priming is timely and can have uncomfortable side effects. However, using a cervical priming agent should be considered in later first-trimester abortions performed between 12 and 14 weeks, and in patients for whom cervical dilation may be challenging, such as adolescents or those with a history of cervical conization. Hegar Dilator 1mm, 030841-1.5 Hegar Dilator 1.5mm, 030841-2 Hegar Dilator 2mm, 030841-2.5 Hegar Dilator 2.5mm, 030841-3 Hegar Dilator 3mm, 030841-3.5 Hegar Dilator 3.5mm, 030841-4 Hegar Dilator 4mm, 030841-4.5 Hegar Dilator 4.5mm, 030841-5 Hegar Dilator 5mm, 030841-5.5 Hegar Dilator 5.5mm, 030842-6 Hegar Dilator 6mm, 030842-6.5 Hegar Dilator 6.5mm, 030842-7 Hegar Dilator 7mm, 030842-7.5 Hegar Dilator 7.5mm, 030842-8 Hegar Dilator8mm, 030842-8.5 Hegar Dilator 8.5mm, 030842-9 Hegar Dilator 9mm, 030842-9.5 Hegar Dilator 9.5mm, 030842-10 Hegar Dilator 10mm, 030842-10.5 Hegar Dilator 10.5mm, 030843-11 Hegar Dilator11mm, 030843-11.5 Hegar Dilator 11.5mm, 030843-12 Hegar Dilator 12mm, 030843-12.5 Hegar Dilator 12.5mm, 030843-13 Hegar Dilator 13mm, 030843-13.5 Hegar Dilator 13.5mm, 030843-14 Hegar Dilator 14mm, 030843-14.5 Hegar Dilator 14.5mm, 030843-15 Hegar Dilator 15mm, 030843-15.5 Hegar Dilator 15.5mm, 030844-16 Hegar Dilator 16mm, 030844-16.5 Hegar Dilator 16.5mm, 030844-17 Hegar Dilator 17mm, 030844-17.5 Hegar Dilator 17.5mm, 030844-18 Hegar Dilator 18mm, 030844-18.5 Hegar Dilator 18.5mm