Use of an osmotic dilator in cases of incomplete abortion to terminate miscarriage in women with severe comorbidity


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Background. The complexity of terminating non-developing pregnancy is that the cervix uteri is not ready and the myometrium is inert, which lead to the prolonged inability of the uterus to expulse an embryo or fetus. The treatment of patients with this pathology uses a large range of drugs, the efficacy of which is not always sufficient, which is due to the severity of the process, reduced immune reactivity, and the presence of severe extragenital diseases. Case reports. The paper describes three complex clinical cases of abortion in cases of intrauterine fetus/embryo death in the presence of severe comorbidity, by applying a Dilapan-S osmotic dilator. Discussion. It is noted that DILAPAN-S not only causes cervical canal dilatation, but, in some cases, results in self- induced miscarriage. Conclusion. This instrument can be separately used to resolve an incomplete abortion in the presence of severe extragenital diseases

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作者简介

Sergey Barinov

Omsk State Medical University

Email: barinov_omsk@mail.ru
MD, Professor, Head of the Department of Obstetrics and Gynecology № 2

Yuliya Tirskaya

Omsk State Medical University

Email: yulia.tirslkaya@yandex.ru
MD, Associate Professor, Department of Obstetrics and Gynecology № 2

Inna Shamina

Omsk State Medical University

Email: innadocsever@rambler.ru
PhD, Assistant, Department of Obstetrics and Gynecology № 2

Irina Medyannikova

Omsk State Medical University

Email: mediren@mail.ru
PhD, Associate Professor, Department of Obstetrics and Gynecology № 2

Lyudmila Shkabarnya

Regional Clinical Hospital

Email: innadocsever@rambler.ru
head of the department of gynecology Omsk

参考

  1. Newmann S., Dalve-Endres A., Drey E.A.; Society of Family Planning. Clinical guidelines. Cervical preparation for surgical abortion from 20 to 24 weeks’ gestation. Contraception. 2008; 77(4): 308-14. doi: 10.1016/j. contraception.2008.01.004.
  2. Lichtenberg E.S. Complications of osmotic dilators. Obstet. Gynecol. Surv. 2004; 59(7): 528-36.
  3. Samuel M.I., Parsons J.H. Hygroscopic dilator (Dilapan-S) and misoprostol combination for the early first-trimester termination of pregnancy: a pilot study. J. Fam. Plann. Reprod. Health Care. 2009; 35(1): 45-7. doi: 10.1783/147118909787072234.
  4. Fox M.C., Krajewski C.M. Cervical preparation for second-trimester surgical abortion prior to 20 weeks’ gestation: SFP Guideline #2013-4. Contraception. 2014; 89(2): 75-84. doi: 10.1016/j.contraception.2013.11.001.
  5. Allen R.H., Goldberg A.B.; Board of Society of Family Planning. Cervical dilation before first-trimester surgical abortion (<14 weeks’ gestation). SFP Guideline 20071. Contraception. 2007; 76(2): 139-56. doi: 10.1016/j. contraception.2007.05.001.

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