The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform
Alisa B Goldberg - One of the best experts on this subject based on the ideXlab platform.
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Cervical Dilation before first trimester surgical abortion 14 weeks gestation
Contraception, 2016Co-Authors: Rebecca H Allen, Alisa B GoldbergAbstract:First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical Dilation before suction abortion is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester include increasing gestational age and provider inexperience. Cervical priming before first-trimester surgical abortion has been studied using osmotic dilators and pharmacologic agents, most commonly misoprostol. Extensive data demonstrate that a variety of agents are safe and effective at causing preoperative Cervical softening and Dilation; however, given the small absolute risk of complications, the benefit of routine use of misoprostol or osmotic dilators in first-trimester surgical abortion is unclear. Although Cervical priming results in reduced abortion time and improved provider ease, it requires a delay of at least 1 to 3 h and may confer side effects. The Society of Family Planning does not recommend routine Cervical priming for first-trimester suction abortion but recommends limiting consideration of Cervical priming for women at increased risk of complications from Cervical Dilation, including those late in the first trimester, adolescents and women in whom Cervical Dilation is expected to be challenging.
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Cervical Dilation before first trimester surgical abortion 14 weeks gestation sfp guideline 20071
Contraception, 2007Co-Authors: Rebecca H Allen, Alisa B GoldbergAbstract:First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical Dilation before suction aspiration is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester are increasing gestational age and provider inexperience. Use of laminaria for Cervical priming reduces the risk of Cervical laceration and, to a lesser extent, uterine perforation. While pharmacological priming agents may potentially have the same effects, no published studies to date have been large enough to assess these outcomes. Given an experienced provider, the risk of these injuries during suction aspiration is very small. Cervical priming can be achieved with osmotic dilators or pharmacological agents. The advantages of osmotic dilators such as laminaria, Dilapan-S and Lamicel are their ability to produce wide Cervical Dilation, and for the synthetic types, their advantages include predictable effects and rapid onset of action. A disadvantage of osmotic dilators is that they require a speculum examination and a trained clinician to perform the insertion. When Cervical priming is performed, misoprostol is the prostaglandin analogue most commonly used worldwide. Compared to laminaria, vaginal misoprostol requires a shorter period of time to achieve the same dilatation, is associated with less discomfort and is preferred by women. The sublingual route appears as effective as vaginal administration and requires less time for priming (2 h), but it is associated with more side effects. Oral administration can produce equivalent Dilation to vaginal or sublingual administration, but higher doses and longer treatment periods (8 to 12 h) are required. Buccal administration of misoprostol appears to have a pharmacokinetic and physiologic profile similar to vaginal administration; however, there are no published studies of buccal misoprostol prior to first-trimester suction abortion. While extensive data demonstrate that a variety of agents are safe and effective at causing Cervical softening and Dilation preoperatively, there are not enough data to conclude that routine Cervical priming is necessary to reduce complications of first-trimester surgical abortion. Cervical priming increases preoperative Cervical Dilation, making the procedure easier and quicker for the physician. However, in order to preoperatively dilate the cervix, the woman must receive the agent at least 3 to 4 h prior to her procedure. Besides the additional waiting, the woman might experience bleeding and cramping prior to the procedure. There are insufficient data evaluating how Cervical priming affects women's quality of life in relation to abortion. Based on existing evidence, the Society of Family Planning does not recommend routine Cervical priming for suction aspiration procedures. The Society of Family Planning further recommends that providers consider Cervical priming only for women who may be at increased risk of complications from Cervical Dilation, including those late in the first trimester, adolescents and women in whom Cervical Dilation is expected to be difficult due to either patient factors or provider experience.
Rebecca H Allen - One of the best experts on this subject based on the ideXlab platform.
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Cervical Dilation before first trimester surgical abortion 14 weeks gestation
Contraception, 2016Co-Authors: Rebecca H Allen, Alisa B GoldbergAbstract:First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical Dilation before suction abortion is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester include increasing gestational age and provider inexperience. Cervical priming before first-trimester surgical abortion has been studied using osmotic dilators and pharmacologic agents, most commonly misoprostol. Extensive data demonstrate that a variety of agents are safe and effective at causing preoperative Cervical softening and Dilation; however, given the small absolute risk of complications, the benefit of routine use of misoprostol or osmotic dilators in first-trimester surgical abortion is unclear. Although Cervical priming results in reduced abortion time and improved provider ease, it requires a delay of at least 1 to 3 h and may confer side effects. The Society of Family Planning does not recommend routine Cervical priming for first-trimester suction abortion but recommends limiting consideration of Cervical priming for women at increased risk of complications from Cervical Dilation, including those late in the first trimester, adolescents and women in whom Cervical Dilation is expected to be challenging.
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Cervical Dilation before first trimester surgical abortion 14 weeks gestation sfp guideline 20071
Contraception, 2007Co-Authors: Rebecca H Allen, Alisa B GoldbergAbstract:First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical Dilation before suction aspiration is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester are increasing gestational age and provider inexperience. Use of laminaria for Cervical priming reduces the risk of Cervical laceration and, to a lesser extent, uterine perforation. While pharmacological priming agents may potentially have the same effects, no published studies to date have been large enough to assess these outcomes. Given an experienced provider, the risk of these injuries during suction aspiration is very small. Cervical priming can be achieved with osmotic dilators or pharmacological agents. The advantages of osmotic dilators such as laminaria, Dilapan-S and Lamicel are their ability to produce wide Cervical Dilation, and for the synthetic types, their advantages include predictable effects and rapid onset of action. A disadvantage of osmotic dilators is that they require a speculum examination and a trained clinician to perform the insertion. When Cervical priming is performed, misoprostol is the prostaglandin analogue most commonly used worldwide. Compared to laminaria, vaginal misoprostol requires a shorter period of time to achieve the same dilatation, is associated with less discomfort and is preferred by women. The sublingual route appears as effective as vaginal administration and requires less time for priming (2 h), but it is associated with more side effects. Oral administration can produce equivalent Dilation to vaginal or sublingual administration, but higher doses and longer treatment periods (8 to 12 h) are required. Buccal administration of misoprostol appears to have a pharmacokinetic and physiologic profile similar to vaginal administration; however, there are no published studies of buccal misoprostol prior to first-trimester suction abortion. While extensive data demonstrate that a variety of agents are safe and effective at causing Cervical softening and Dilation preoperatively, there are not enough data to conclude that routine Cervical priming is necessary to reduce complications of first-trimester surgical abortion. Cervical priming increases preoperative Cervical Dilation, making the procedure easier and quicker for the physician. However, in order to preoperatively dilate the cervix, the woman must receive the agent at least 3 to 4 h prior to her procedure. Besides the additional waiting, the woman might experience bleeding and cramping prior to the procedure. There are insufficient data evaluating how Cervical priming affects women's quality of life in relation to abortion. Based on existing evidence, the Society of Family Planning does not recommend routine Cervical priming for suction aspiration procedures. The Society of Family Planning further recommends that providers consider Cervical priming only for women who may be at increased risk of complications from Cervical Dilation, including those late in the first trimester, adolescents and women in whom Cervical Dilation is expected to be difficult due to either patient factors or provider experience.
Roxanne Jamshidi - One of the best experts on this subject based on the ideXlab platform.
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paraCervical block with combined ketorolac and lidocaine in first trimester surgical abortion a randomized controlled trial
Obstetrics & Gynecology, 2009Co-Authors: Catherine D Cansino, Alison Edelman, Anne E. Burke, Roxanne JamshidiAbstract:OBJECTIVE To study the effects of a paraCervical block with combined ketorolac and lidocaine on perceived pain during first-trimester surgical abortion. METHODS A double-masked, placebo-controlled, randomized clinical trial of 50 women undergoing first-trimester surgical abortions (before 11 weeks of gestation) received either oral ibuprofen with a lidocaine-alone paraCervical block or an oral placebo and paraCervical block with combined ketorolac and lidocaine. Women completed a series of 100-mm visual analog scales (anchors: 0=none, 100 mm=worst imaginable) to measure their perceived pain (anticipated pain, pain during and after surgical abortion, and total satisfaction). RESULTS Twenty-five women received preoperative oral ibuprofen followed by paraCervical block with lidocaine alone, and 25 received oral placebo followed by paraCervical block with combined ketorolac and lidocaine. Groups were similar with respect to sociodemographic variables. Women who received paraCervical block with combined ketorolac and lidocaine reported significantly less pain after Cervical Dilation (59.8 compared with 74.8 mm, P<.05). The groups did not differ in perceived procedure-related or postoperative pain. There was no difference in overall satisfaction with pain control between the two groups (63.6 compared with 62.9 mm, P=.93). CONCLUSION ParaCervical block with combined ketorolac and lidocaine significantly decreases perceived pain associated with Cervical Dilation during first-trimester surgical abortion. This analgesic mixture may be offered as an alternative pain regimen to women seeking first-trimester surgical abortion. It may also offer improved pain control in other gynecologic procedures necessitating Cervical Dilation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00617097. LEVEL OF EVIDENCE I.
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ParaCervical block with combined ketorolac and lidocaine in first-trimester surgical abortion: a randomized controlled trial.
Obstetrics and gynecology, 2009Co-Authors: Catherine D Cansino, Alison Edelman, Anne E. Burke, Roxanne JamshidiAbstract:To study the effects of a paraCervical block with combined ketorolac and lidocaine on perceived pain during first-trimester surgical abortion. A double-masked, placebo-controlled, randomized clinical trial of 50 women undergoing first-trimester surgical abortions (before 11 weeks of gestation) received either oral ibuprofen with a lidocaine-alone paraCervical block or an oral placebo and paraCervical block with combined ketorolac and lidocaine. Women completed a series of 100-mm visual analog scales (anchors: 0=none, 100 mm=worst imaginable) to measure their perceived pain (anticipated pain, pain during and after surgical abortion, and total satisfaction). Twenty-five women received preoperative oral ibuprofen followed by paraCervical block with lidocaine alone, and 25 received oral placebo followed by paraCervical block with combined ketorolac and lidocaine. Groups were similar with respect to sociodemographic variables. Women who received paraCervical block with combined ketorolac and lidocaine reported significantly less pain after Cervical Dilation (59.8 compared with 74.8 mm, P<.05). The groups did not differ in perceived procedure-related or postoperative pain. There was no difference in overall satisfaction with pain control between the two groups (63.6 compared with 62.9 mm, P=.93). ParaCervical block with combined ketorolac and lidocaine significantly decreases perceived pain associated with Cervical Dilation during first-trimester surgical abortion. This analgesic mixture may be offered as an alternative pain regimen to women seeking first-trimester surgical abortion. It may also offer improved pain control in other gynecologic procedures necessitating Cervical Dilation. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00617097. I.
Vincenzo Berghella - One of the best experts on this subject based on the ideXlab platform.
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novel device versus manual examinations for the measurement of Cervical Dilation in labor a randomized controlled trial
American journal of obstetrics & gynecology MFM, 2021Co-Authors: Eva L Martin, Brandy Firman, Vincenzo BerghellaAbstract:BACKGROUND Cervical Dilation and changes in Cervical Dilation inform the management of labor, including decisions to admit a patient to the hospital, augment labor, or perform a cesarean delivery. Practitioners routinely measure Cervical Dilation subjectively using 2 fingers on manual examination; however, agreement of ≤1 cm between 2 observers has been reported as 60% to 91% previously in laboring women. OBJECTIVE To evaluate the agreement among different providers' examinations using DilaCheck (interexaminer agreement) compared with interexaminer agreement between 2 manual examinations for Cervical Dilation of women in labor. STUDY DESIGN Women admitted in labor to a labor and delivery service were randomized to receive 2 Cervical examinations from trained providers, using either a novel device (DilaCheck) or the standard manual examination. This randomized controlled trial compares a novel device with the standard method of manual examination for the measurement of Cervical Dilation. The novel device consisted of a string measuring tape suspended between 2 soft plastic rings worn on the index and middle fingertips. Interobserver agreement, defined as the agreement (exact, ≤1 cm [primary outcome], or ≤2 cm) in the numeric Cervical Dilation measurement obtained by 2 different examiners, was compared between the 2 groups. RESULTS A total of 42 women in labor were randomized, 21 to the novel device and 21 to the standard manual examination groups. The 2 device examinations agreed in 19% of cases, whereas manual examinations agreed exactly in 42.9% of cases (P=.10). Interobserver agreement of ≤1 cm was 61.9% vs 95.2%, respectively (P=.008). Interobserver agreement of ≤2 cm was 90.5% vs 100%, respectively (P=.15). Most interobserver disagreement was seen at 5 to 7 cm of Cervical Dilation. CONCLUSION A novel device, DilaCheck, intended for a more objective Cervical assessment of women in labor did not improve interobserver agreement; in fact, it decreased it. Standard Cervical Dilation examinations result in poor interexaminer exact agreement, usually at best 50% or less. Clinical management should be based on clinical differences of >1 cm because, in general, 90% of Cervical examinations will agree within 1 cm of each other. Given the importance of Dilation measurements in the management of labor, continued innovation in this field would benefit women in labor and the providers caring for them; however, the puzzle remains unsolved.
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Novel device versus manual examinations for the measurement of Cervical Dilation in labor: a randomized controlled trial.
American journal of obstetrics & gynecology MFM, 2021Co-Authors: Eva L Martin, Brandy Firman, Vincenzo BerghellaAbstract:ABSTRACT Background Cervical Dilation and changes in Cervical Dilation inform the management of labor, including decisions to admit a patient to the hospital, augment labor, or perform a cesarean section. Practitioners routinely measure Cervical Dilation subjectively using two fingers on manual examination; however, agreement ≤1cm between two observers has been reported as 60-91% previously in laboring women. Methods Women admitted in labor to a Labor & Delivery service were randomized to receive two Cervical examinations from trained providers, either using a novel device (DilaCheck®) or the standard manual examination. This randomized controlled trial compares a novel device with the standard method of manual examination for the measurement of Cervical Dilation. The novel device consisted of a string measuring tape suspended between two soft plastic rings worn on the index and middle fingertips. Inter-observer agreement, defined as the agreement (exact, ≤1cm - primary outcome - or ≤2cm) in the numerical Cervical Dilation measurement obtained by two different examiners, was compared between the two groups. Results A total of 42 women in labor were randomized, 21 to the novel device and 21 to the standard manual examination groups. The two device examinations agreed in 19% of cases, while manual examinations agreed exactly in 42.9% of cases (p=0.10). Inter-observer agreement ≤1cm was 61.9% vs. 95.2%, respectively (p=0.008). Inter-observer agreement ≤2cm was 90.5% vs. 100%, respectively (p=0.15). Most inter-observer disagreement was seen at 5-7cm of Cervical Dilation. Conclusion A novel device, DilaCheck, intended for more objective Cervical assessment of women in labor, did not improve inter-observer agreement; in fact, it decreased it. Standard Cervical Dilation examinations result in poor inter-examiner exact agreement, usually at best 50% or less. Clinical management should be based on clinical differences of >1cm because, in general, 90% of Cervical examinations will agree within 1cm of each other. Given the importance of Dilation measurements in the management of labor, continued innovation in this field would benefit women in labor and the providers caring for them; however, the puzzle remains unsolved.
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predicting asymptomatic Cervical Dilation in pregnant patients with short mid trimester Cervical length a secondary analysis of a randomized controlled trial
Acta Obstetricia et Gynecologica Scandinavica, 2019Co-Authors: Rupsa C Boelig, Vincenzo Berghella, Lorraine Dugoff, Amanda Roman, Jack LudmirAbstract:Introduction Second trimester asymptomatic Cervical Dilation is a significant risk factor for early preterm birth. The objective of this study is to evaluate whether transvaginal ultrasound Cervical length (CL) predicts asymptomatic Cervical Dilation on physical exam in women with short cervix (CL ≤25 mm) and no prior preterm birth. Material and methods Secondary analysis of a randomized trial on pessary in asymptomatic singletons without prior preterm birth diagnosed with CL ≤25 mm between 18+0/7 and 23+6/7 weeks. Participants had transvaginal ultrasound and physical Cervical exam and were randomized to pessary or no pessary with all patients with Cervical length ≤20 mm offered vaginal progesterone. The primary outcome was to determine whether CL was predictive of asymptomatic physical Cervical Dilation ≥1 cm using receiver operating characteristic curve. Results In all, 119 women were included. Based on receiver operating characteristic curve, CL ≤11 mm was best predictive of Cervical Dilation ≥1 cm, with 75% sensitivity, 80% specificity, and area under the curve 0.73 (0.55-0.91), P = 0.009. Cervical length ≤11 mm had increased incidence of Cervical Dilation ≥1 cm on physical exam (30% vs 3%, odds ratio 12.29 (3.05-49.37) P 11 mm. Conclusions Among singletons without prior preterm birth diagnosed with short cervix (≤25 mm), CL ≤11 mm may identify a subgroup of patients at high risk for asymptomatic Cervical Dilation and poor perinatal outcome. Physical exam should be considered and adjunctive preterm birth prevention measures should be studied in singletons with CL ≤11 mm.
Robert A. Munsick - One of the best experts on this subject based on the ideXlab platform.
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Cervical Dilation from multiple laminaria tents used for abortion
Obstetrics and gynecology, 1996Co-Authors: Robert A. Munsick, Naomi S. FinebergAbstract:Objective To quantify the Cervical Dilation achieved from multiple medium-thick laminaria tents used for 16–26 hours in single applications before abortion. Methods In a practice setting, Cervical Dilation was studied from all abortions done at greater than 8 weeks in which one or more medium-thick laminaria tents were used in a single application for 16–26 hours. Multiple regression analysis was used to quantify results. Results There was a positive linear regression of Dilation against weeks of gestation for all numbers of tents. The more tents, the greater the Dilation; the more weeks, the greater the Dilation. Conclusion Approximate Cervical circumferential Dilation from medium-thick laminaria tents under the constraints listed is provided by the formula: Pratt Dilation = 12.36 + (2.35 × tents) + (1.79 × weeks).
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Cervical Dilation from laminaria tents and synthetic osmotic dilators used for 6 hours before abortion
Obstetrics & Gynecology, 1995Co-Authors: Sarah B Kline, Hua Meng, Robert A. MunsickAbstract:Objective To compare thick laminaria tents with two synthetic osmotic devices for softening and dilating the cervix before abortions. Methods This was a randomized clinical trial comparing Cervical Dilation by thick laminaria tents with two commercially made devices, 3-mm Hypan and 3-mm anhydrous magnesium sulfate-impregnated plastic tents, used for 6 hours. Subjects were 7–14 weeks pregnant, and all 93 were assigned to devices in permuted randomized groups of three. Physicians and patients were not blinded to the type of device used. Need for a tenaculum for insertions, ease of introduction, cramps, removal ease, hourglassing, achieved Dilation, and ease of forced Dilation were compared. The effects of parity and gestational length on achieved Dilation were also analyzed. Results Parity did not affect Dilation. Significant positive, linear slopes of regression were found for achieved Dilation versus weeks of gestation for thick laminaria tents and magnesium sulfate devices but not for Hypan tents. Forcible Dilation was easiest with thick laminaria tents and most difficult with magnesium sulfate devices. Conclusion All devices provided safe Cervical Dilation and softening, but thick tents were most effective.