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Dilation and evacuation can be offered for management of second trimester miscarriage if skilled providers are available. [6] Some women choose D&E over labor induction for a second trimester loss because it can be a scheduled surgical procedure, offering predictability over labor induction, or because they find it emotionally easier than undergoing labor and delivery.
Cervical dilation may be induced mechanically by placing devices inside the cervix that will expand while in place. A balloon catheter may be used. Other products include osmotic dilators , such as laminaria stick (made of dried seaweed) or synthetic hygroscopic materials, which expand when placed in a moist environment.
It has been estimated that cervical insufficiency complicates about 1% of pregnancies, and that it is a cause in about 8% of women with second trimester recurrent miscarriages. [2] A sign of cervical weakness is funneling at the internal orifice of the uterus, which is a dilation of the cervical canal at this location. [3]
Intact dilation and extraction (D&X, IDX, or intact D&E) is a surgical procedure that terminates and removes an intact fetus from the uterus.The procedure is used both after miscarriages and for abortions in the second and third trimesters of pregnancy.
Dilation (or dilatation) and curettage (D&C) refers to the dilation (widening or opening) of the cervix and surgical removal of sections and/or layers of the lining of the uterus and or contents of the uterus such as an unwanted fetus (early abortion before 13 weeks), remains of a non-viable fetus, retained placenta after birth or abortion as well as any abnormal tissue which may be in the ...
The heart rate increases, but generally not above 100 beats/ minute. Total systematic vascular resistance decreases by 20% secondary to the vasodilatory effect of progesterone. Overall, the systolic and diastolic blood pressure drops 10–15 mm Hg in the first trimester and then returns to baseline in the second half of pregnancy. [6]
In 2009, medical abortion regimens using mifepristone in combination with a prostaglandin analog were the most common methods used to induce second-trimester abortions in Canada, most of Europe, China and India; [7] in contrast to the US, where 96% of second-trimester abortions were performed surgically by dilation and evacuation. [95]
Usually the treatment is done in the first or second trimester of pregnancy, for a woman who has had one or more late miscarriages in the past. [2] The word "cerclage" means encircling, hooping or banding in French. [3] The success rate for cervical cerclage is approximately 80–90% for elective cerclages, and 40–60% for emergency cerclages.
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