| Complications of osmotic dilators. | |
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MedLine Citation:
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PMID: 15199271 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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This article reviews safety, efficacy, and complications of intracervical osmotic devices and discusses diagnostic, therapeutic, and preventative measures for managing them. Osmotic dilators have been used to ripen the cervix in gynecologic and obstetric procedures for centuries. Their gradual effect in softening and dilating the cervix reduces the chance of stretch injury or perforation and could enhance completeness of evacuation of the uterine cavity. Natural and synthetic devices are available, each with unique properties. Notwithstanding major advances in prostaglandin analogs as cervical ripeners, these mechanical devices continue to play a vital role in cervical preparation. In the event of an unfavorable cervix, they are adjuncts for accelerating inductions of labor and for safe uterine entry during hysteroscopy and diagnostic dilation and curettage. For inducing pregnancy, they are routinely used as cervical ripeners from the late first trimester onward. The English-language literature was surveyed. The author used citations from a MEDLINE search, 2 unpublished case reports, and personal experience. Laminaria and Dilapan dilators can get trapped and fragment with the potential for serious adverse clinical and legal consequences. Lamicel devices do not share this feature. Serious infection is uncommon and anaphylaxis is rare. Timely, well-selected imaging techniques can aid diagnosis. Preventative measures could reduce the number and severity of osmotic dilator-associated complications. Measures suggested by some include predilating with metal dilators, incorporating laminaria or Lamicel devices with Dilapan, adding misoprostol, and using sonohysterography. However, these measures, singly and in combination, are unlikely to eliminate all complications. |
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Authors:
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E Steve Lichtenberg |
Publication Detail:
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Type: Case Reports; Journal Article; Review |
Journal Detail:
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Title: Obstetrical & gynecological survey Volume: 59 ISSN: 0029-7828 ISO Abbreviation: Obstet Gynecol Surv Publication Date: 2004 Jul |
Date Detail:
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Created Date: 2004-06-16 Completed Date: 2004-09-23 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 0401007 Medline TA: Obstet Gynecol Surv Country: United States |
Other Details:
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Languages: eng Pagination: 528-36 Citation Subset: IM |
Affiliation:
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Northwestern University Feinberg Medical School, Chicago, Illinois, USA. chicago@fpamg.net |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Abortion, Induced
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instrumentation Adult Anaphylaxis / etiology Balloon Dilatation / adverse effects Cervix Uteri* / injuries Device Removal / adverse effects Dilatation / adverse effects*, instrumentation Equipment Safety Female Gynecology / instrumentation*, legislation & jurisprudence, methods Humans Infection / etiology Laminaria* Malpractice / legislation & jurisprudence Obstetrics / instrumentation*, legislation & jurisprudence, methods Osmosis Polymers / adverse effects* Pregnancy Treatment Outcome United States |
| Chemical | |
Reg. No./Substance:
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0/Polymers; 123535-69-3/dilapan |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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