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. 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]. 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. Pratt dilators have long tapered tips allowing the operator to use the least mechanical force; for this reason, the Pratt dilator is commonly preferred. Pratt dilators are sized from 9 to 79 French. The French unit is the diameter of the dilator in millimeters. Dividing the French unit by 3, a rough estimate of Pi, yields the diameter of the dilator in millimeters. [8] Indications for a D&C in the pregnant patient include elective termination of pregnancy, early pregnancy failure, evacuation of a molar pregnancy, or suspected retention of products of conception. The pregnant D&C is usually performed with either manual or electric vacuum aspiration. In addition, a D&C may be used to evaluate the chorionic villi in a patient who has a pregnancy of unknown location.

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. Unlike a D&E, where cervical preparation is recommended, cervical preparation for a D&C need only be considered. The2 most commonly used cervical preparations are osmotic dilators or chemical ripening agents.Otherwise, the general rule of thumb is to start with the smallest you can find and work your way up gradually.

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. The only absolute contraindication to a D&C is the desire to maintain a viable intrauterine pregnancy. If your child had a colostomy before this surgery, the colostomy may be closed when the goal size of the anus is reached. After the colostomy is closed, you will still need to dilate your child’s anus until the dilator goes in easily with no discomfort. This will likely be about 3-4 weeks after you get to the last size dilator.If you’re using a silicone dilator, use a water-based lube like #LubeLife instead. Remember: Silicone breaks down silicone. Choose the best position Bakes sounds, also known as rosebud or bullet sounds, have a long thin metal rod with a bulbous bud on the end.

Minor discomfort is normal, but more than that means it’s time to slowly pull out and try again when you’re ready. 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 unwindThe3 most common types of dilators are steel Pratt dilators, Hank dilators, and Hegar dilators. No trials have compared the safety or efficiency of these different dilator sets. [8] They are also available in sets of 8, 14 and 26 with or without metal case to suit different surgical needs.