TY - JOUR
T1 - Prevalence and risk factors of inadequate cervical dilation following laminaria insertion in second-trimester abortion - Case control study
AU - Ben-Ami, Ido
AU - Stern, Sharon
AU - Vaknin, Zvi
AU - Smorgick, Noam
AU - Schneider, David
AU - Halperin, Reuvit
N1 - Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Objective The objective was to explore the prevalence of and risk factors for inadequate cervical dilation following insertion of a single set of laminaria in women scheduled for dilation and evacuation (DandE) at 14-24 weeks' gestation. Study design We retrospectively reviewed all cases of women who underwent pregnancy termination by DandE at 14-24 weeks' gestation between January 2003 and December 2013. All cases in which the surgical procedure was cancelled due to failure to achieve adequate cervical dilation after a single set of laminaria inadequate cervical dilation were included. The control group was women who underwent DandE following adequate cervical dilation after a single set of laminaria, and were matched according to gestational week in a ratio of 1:3. Results The overall dilation failure rate was 3.2%, with 4.0% among the induced-abortion patients and 1.5% among the patients with fetal demise (p=.002). Patients who had inadequate cervical dilation had lower rates of gravidity (p=.002) and previous spontaneous vaginal delivery (p<.001), along with higher rates of primigravidity, nulliparity (p<.001), previous cesarean section/s (p=.041), previous abdominal surgeries (p=.001) and previous cervical procedures (p=.003), compared to controls. A multivariable logistic regression analysis revealed two risk factors for inadequate cervical dilation following laminaria insertion, namely, previous cesarean section (p=.002) and previous cervical procedure (p<.001), whereas increased gravidity was found to protect against inadequate cervical dilation (p=.002). Conclusions Previous cesarean section/s, cervical procedures and primigravidity were found to be risk factors for failure to achieve adequate cervical dilation after a single set of laminaria. Women who are scheduled for DandE, and in whom one of these risk factors exists, might benefit from additional interventions to achieve better cervical preparation.
AB - Objective The objective was to explore the prevalence of and risk factors for inadequate cervical dilation following insertion of a single set of laminaria in women scheduled for dilation and evacuation (DandE) at 14-24 weeks' gestation. Study design We retrospectively reviewed all cases of women who underwent pregnancy termination by DandE at 14-24 weeks' gestation between January 2003 and December 2013. All cases in which the surgical procedure was cancelled due to failure to achieve adequate cervical dilation after a single set of laminaria inadequate cervical dilation were included. The control group was women who underwent DandE following adequate cervical dilation after a single set of laminaria, and were matched according to gestational week in a ratio of 1:3. Results The overall dilation failure rate was 3.2%, with 4.0% among the induced-abortion patients and 1.5% among the patients with fetal demise (p=.002). Patients who had inadequate cervical dilation had lower rates of gravidity (p=.002) and previous spontaneous vaginal delivery (p<.001), along with higher rates of primigravidity, nulliparity (p<.001), previous cesarean section/s (p=.041), previous abdominal surgeries (p=.001) and previous cervical procedures (p=.003), compared to controls. A multivariable logistic regression analysis revealed two risk factors for inadequate cervical dilation following laminaria insertion, namely, previous cesarean section (p=.002) and previous cervical procedure (p<.001), whereas increased gravidity was found to protect against inadequate cervical dilation (p=.002). Conclusions Previous cesarean section/s, cervical procedures and primigravidity were found to be risk factors for failure to achieve adequate cervical dilation after a single set of laminaria. Women who are scheduled for DandE, and in whom one of these risk factors exists, might benefit from additional interventions to achieve better cervical preparation.
KW - Abortion
KW - Dilatation and evacuation
KW - Inadequate cervical dilation
KW - Laminaria
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=84925356443&partnerID=8YFLogxK
U2 - 10.1016/j.contraception.2014.12.012
DO - 10.1016/j.contraception.2014.12.012
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C2 - 25575873
AN - SCOPUS:84925356443
SN - 0010-7824
VL - 91
SP - 308
EP - 312
JO - Contraception
JF - Contraception
IS - 4
ER -