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] Vaginal preparation with an antiseptic solution is generally performed to reduce the risk of post-abortioninfection. There is limited evidence that preparation with chlorhexidine or povidone-iodine is superior to saline alone, but studies are inadequate. There is data to support that vaginal bacterial load is reduced when using the chlorohexidine solution, but this study was not powered to examine clinical outcomes. [11] Preparation is key anytime you’re inserting anything in your butt. It can make or break your experience… and your anus. Cervical incompetence (CI) is one of the main causes of premature birth or miscarriage in the second trimester. According to statistics, 8% of miscarriages in the second trimester and premature births are due to CI ( 1). If a patient has a history of typical painless cervical dilation during the second trimester, and a No. 7 Hegar dilator can pass through the internal cervical os without resistance during the nonpregnancy period, the diagnosis of CI can be confirmed ( 2). The surgical treatment of CI is cervical cerclage which refers to a variety of procedures that use sutures or synthetic tape to reinforce the cervix. Cervical cerclage can be done through the vagina (transvaginal cervical cerclage) or, less commonly, through the abdomen (transabdominal or laparoscopic cervical cerclage). The prophylactic cervical cerclage should preferably be performed before or in the early period of pregnancy. Both approaches have their own advantages and disadvantages. Currently, the most commonly used method is the transvaginal approach, but upon its failure, laparoscopic cervical cerclage is recommended.

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 procedure isinitiated by dilating the cervix with the smallest accommodating dilator; the dilator size is then sequentially increased. The dilator must pass through the external and internal os. Providers learn to identify this landmark with the loss of mild resistance under gentle pressure. The dilator should be held using only two fingers of the dominant hand,and forceshould not be excessive; excessive force may increase the risk of uterine perforation. The extent of dilation will be determined by the amount of tissue to be removed and the size of the chosen curette. After adequate dilation, the metal or plastic curette is inserted through the endocervical canal into the endometrial cavity and gently advanced to the uterine fundus.

Laminaria rods have also been used to open up the cervix but work slowly as they increase size by absorbing water. Osmotic dilators, such as laminaria and Dilapan-S, are established, safe, and effective ways to dilate a cervix; both require overnight placement. [9]These agents are placed through the external cervical os into the endocervical canal and absorb moisture from the cervix, slowly expanding and dilating the canal.

We manufacture Hegar dilators with premium quality surgical grade chrome plated brass that can be sterilised and reused. Cervical injury or lacerations to the lip of the cervix typically occur when too much traction is applied to the cervix during dilation or manipulation. Most lacerations can be managed with pressure, silver nitrate, or ferric subsulfate. Occasionally suture ligation is needed. If there is an injury to the endocervical canal, pressure or suture should be attempted first. If there is no response, then balloon tamponade or uterine artery embolization with further evaluation for abdominal or retroperitoneal bleeding should be considered. Uterine sounds [ edit ] Uterine dilators of Hegar type, from diameters 4 mm (right) to 17 mm (left). These sounds are intended for probing a woman's uterus through the cervix, to measure the length and direction of the cervical canal and uterus. Dilators are primarily used to open and dilate the cervix to gain access to the uterine cavity, but can also be used as sounds.

They are also available in sets of 8, 14 and 26 with or without metal case to suit different surgical needs. 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. 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. Most dilator kits, like this one from VuVatech, start at around 0.5 inches in diameter, which is a good starting point for most.

If dilation is the only goal, there’s no reason to keep it inside once you’ve managed to get it in all the way. Look for dilators made from body-safe materials, such as medical-grade silicone, that are free of phthalates and BPA. a b Doleys, Daniel (6 December 2012). Behavioral Medicine. Springer Science & Business Media. p.377. ISBN 9781468440706. If it goes in easily, you can start again, repeating these steps with the next size up in your kit. 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.

Lube is a must to help ease the dilator in and prevent tearing. Apply a liberal amount of lube to the tip of the dilator and around your anal opening.