Dilation and Evacuation in the Setting of Trachelectomy and Abdominal Cerclage: A Case Report and Review of the Literature. This is a patient with a history of radical trachelectomy and abdominal cerclage who underwent an uncomplicated dilation and evacuation at 15 weeks gestation with mifepristone preparation. Dilation and evacuation may be attempted and safely completed for patients
Hysteroscopic resection vs ultrasound-guided dilation and evacuation for treatment of cesarean scar ectopic pregnancy: a randomized clinical trial Cesarean scar ectopic pregnancy (CSP) is a type of ectopic pregnancy where the fertilized egg is implanted in the muscle or fibrous tissue of the scar after a previous cesarean section. The condition can be catastrophic if not managed on time, leading to significant morbidity and mortality. Several approaches have been studied for management of CSP in women who opted for termination of pregnancy, with no consensus on the best treatment modality reached so far. To compare the success rate of hysteroscopic resection vs ultrasound-guided dilation and evacuation (D&E) for treatment of CSP. Parallel group, nonblinded, randomized clinical trial conducted
Adjuvant misoprostol or mifepristone for cervical preparation with osmotic dilators before dilation and evacuation. To compare effectiveness and safety of cervical preparation with osmotic dilators plus same-day misoprostol or overnight mifepristone prior to dilation and evacuation (D&E). We conducted a retrospective cohort analysis of 664 patients initiating abortion between 18 and 22 weeks
Outcomes After Induction of Labor Compared With Dilation and Evacuation for the Management of Rupture of Membranes in the Second Trimester. Previable and periviable rupture of membranes is associated with significant morbidity for the pregnant patient. For those who have a choice of options and undergo active management, it is not known how the risks of induction of labor compare with those for dilation and evacuation (D&E). We performed a retrospective cohort study of patients with rupture of membranes between 14 0/7 and 23 6/7 weeks of gestation who opted for active management. Adverse events (52.2% vs 16.9%, P<.01) and time to uterine evacuation greater than 24 hours (26.7% vs 9.6%, P=.01) were more common among patients undergoing induction of labor. In a multivariable regression, induction
Acute complications with same-day versus overnight cervical preparation before dilation and evacuation at 14 to 16 weeks. Evaluate if same-day cervical preparation is associated with a clinically acceptable complication rate compared with overnight osmotic dilators for dilation and evacuation (D&E). This retrospective, noninferiority, cohort study compared complication rates for same-day versus trimester dilation and evacuation, same-day cervical preparation should be considered a safe alternative to overnight cervical preparation.
A Case of Asymptomatic Uterine Incarceration in a Patient Undergoing Dilation and Evacuation. Uterine incarceration is a rare pregnancy complication that occurs when the uterine fundus becomes trapped beneath the sacral promontory. We present a case of incarceration in a patient seeking dilation and evacuation (D&E) and a discussion of strategies for uterine reduction and cervical preparation.
Characteristics and outcomes of patients undergoing second-trimester dilation and evacuation for intrauterine fetal demise versus induced abortion. Patients with intrauterine fetal demise (IUFD) are at higher risk of complications when undergoing dilation and evacuation (D&E) compared to patients undergoing abortion for other indications. We aimed to compare baseline characteristics and describe
Gabapentin as an adjunct for pain management during dilation and evacuation: A double-blind randomized controlled trial. To assess the analgesic efficacy of preoperative gabapentin among patients undergoing dilation and evacuation (D&E) with moderate sedation. We conducted a randomized, controlled, double-blind trial among patients undergoing same-day D&E at 14 to 19 weeks gestation under
Oxytocin and Hypotension During Dilation and Evacuation Procedures at 18-24 Weeks Gestation. Oxytocin is a neurohormone that is routinely administered to patients during dilation and evacuation procedures (D&E) to control bleeding despite minimal evidence in support of this common practice. In this study, the authors sought to evaluate patients with hypotension after receiving oxytocin during D&E
Mifepristone prior to osmotic dilators for dilation and evacuation cervical preparation: A randomized, double-blind, placebo-controlled pilot study. To evaluate mifepristone impact on osmotic dilator placement and procedural outcomes when given 18 to 24 hours before dilator placement for dilation and evacuation (D&E) at 18 weeks 0 days to 23 weeks 6 days gestation. We performed a randomized
Same-Day Compared With Overnight Cervical Preparation Before Dilation and Evacuation Between 16 and 19 6/7 Weeks of Gestation: A Randomized Controlled Trial. We performed a double-blind, placebo-controlled, randomized noninferiority trial to compare same-day osmotic dilators plus misoprostol with overnight osmotic dilators alone for cervical preparation before dilation and evacuation (D&E
Vomiting and risk of endotracheal intubation related to preoperative doxycycline use for dilation and evacuation. To describe the rate of vomiting from oral doxycycline 200 mg given the night before second trimester dilation and evacuation (D&E), proportion of anesthesia modalities, and anesthetic complications. We conducted a single-institution retrospective cohort study of patients presenting
Expulsion of a fragmented laminaria one week after a same-day dilation and evacuation procedure. We describe a complication from same-day cervical preparation with simultaneous use of Aquacryl hydrogel osmotic dilator, laminaria and misoprostol vaginally for a same-day dilation and evacuation procedure at 19 weeks' gestation. The laminaria fragmented and embedded in the cervix at the time
Dilation and evacuation with an abdominal cerclage at 21 weeks gestation: A case report. This case demonstrates a successful dilation and evacuation (D&E) at 21 weeks gestation for a patient with abdominal cerclage without initial advanced dilation. We followed a 2-day protocol with placement of 5 laminaria and mifepristone for cervical preparation without complication.
Fetomaternal hemorrhage assessment in Rh-negative patients undergoing dilation and evacuation between 20 and 24 weeks' gestational age: A retrospective cohort study. To estimate the rate of requiring more than one 300-mcg Rh D immune globulin dose for fetomaternal hemorrhage (FMH) at the time of second-trimester dilation and evacuation (D + E). We performed a retrospective cohort analysis
Clinical interventions are more accurate than quantitative measurements for defining hemorrhage with dilation and evacuation. To assess if quantitative blood loss (QBL) with dilation and evacuation (D&E) procedures correlated with clinically relevant outcomes or hemorrhage. We used a de-identified database to review D&E procedures performed at UC Davis Health from April 2019 through March 2020
A randomized controlled trial of methylergonovine prophylaxis after dilation and evacuation abortion. To evaluate the efficacy of intramuscular methylergonovine maleate as prophylaxis against excessive bleeding when given after dilation and evacuation (D&E) at 20-24 weeks. We performed a randomized, double-blinded, placebo-controlled trial in patients without excessive bleeding requiring . When administered prophylactically immediately after dilation and evacuation abortion at 20-24 weeks, methylergonovine increases uterine bleeding. Given the lack of data for effectiveness as a prophylactic agent and our findings indicating harm, we do not recommend its use for post-operative prophylaxis.
Complication rates of dilation and evacuation and labor induction in second-trimester abortion for fetal indications: A retrospective cohort study. To compare complication rates of dilation and evacuation (D&E) to mifepristone and misoprostol labor induction for second trimester abortion for fetal indications. We performed a retrospective cohort study comparing complication rates with D&E
Dilation and evacuation after preterm premature rupture of membranes with abdominal cerclage in situ. For women with a history of cervical insufficiency, treatment with transvaginal (TV) or abdominal (TA) cerclage is often recommended; however management of pregnancy complications necessitating uterine evacuation in the second trimester are challenging. We present a patient at 17 weeks 3 day gestation with preterm premature rupture of membranes, and chorioamnionitis with an abdominal cerclage in situ. She desired uterine evacuation via dilation and evacuation. This case report reviews the clinical considerations for uterine evacuation in the second trimester in patients with an abdominal cerclage in situ and discusses options for cervical preparation prior to dilation and evacuation
Society of Family Planning clinical recommendations: Cervical preparation for dilation and evacuation at 20-24 weeks' gestation. Although only 1.3% of abortions in the United States are between 20 and 24 weeks' gestation, these procedures are associated with elevated risks of morbidity and mortality. Adequate cervical preparation before dilation and evacuation (D&E) at 20-24 weeks' gestation