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      Experiencia con un dispositivo para dilatación cervical controlada Translated title: Experience with a device for controlled cervical dilation

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          Abstract

          Resumen OBJETIVO: Observar y valorar la eficacia y seguridad en humanos de este nuevo dispositivo para dilatación cervical. MATERIALES Y MÉTODOS: Estudio prospectivo, experimental y de intervención, efectuado en pacientes atendidas entre los meses de enero a diciembre de 2015 en el Hospital General Santa María del Puerto (España) a quienes se realizaron procedimientos diagnósticos y terapéuticos ginecológicos que requirieron dilatación cervical; se utilizó el dispositivo Aqueduct-100®. RESULTADOS: se estudiaron 50 pacientes con edad media de 50 años. Hubo dos grupos de tratamiento: 1) 38 pacientes con dilatación de 5 minutos y 2) 12 con 3 minutos. La indicación más frecuente del procedimiento fue la histeroscopia diagnóstica (44%). El diámetro cervical medio, inicial y posterior al procedimiento, fue de 2.8 y 7.7 mm, respectivamente. La valoración del dispositivo por los especialistas fue de buena a excelente. No se registraron complicaciones relacionadas con el proceso de dilatación cervical. CONCLUSIONES: El dispositivo estudiado es una alternativa sencilla y efectiva para la realización de maniobras de dilatación cervical, previas a diversos procedimientos intrauterinos y endometriales.

          Translated abstract

          Abstract OBJECTIVE: To observe and assess the efficacy and safety of this new cervical dilator device, for the first time in humans. Thus, if the study is successful, raise a second phase through a randomized clinical trial, which purpose shall be to show if there is a superiority of this device with respect to common mechanics dilators. MATERIALS AND METHODS: Prospective, experimental intervention study, in patients undergoing gynecological diagnostic and therapeutic procedures, requiring cervical dilatation, using the Aqueduct - 100®, the Hospital General Santa María del Puerto (Spain). The study included 50 patients who met the criteria for inclusion, in the period January-December 2015. RESULTS: The mean age of the patients was 52.6 years. They were divided into two treatment groups: 38 patients were subjected to a process of expansion of 5 minutes and 12 3-minute processes. The description of the most frequent procedure was the realization of a diagnostic Hysteroscopy (44%). The cervical diameter medium, both initial and subsequent procedure was 2.8 and 7.7 mm, respectively. The valuation of the device by the specialists who used it, ranged between good and excellent rating for all items. There was no complication associated with the process of cervical dilatation with the device. CONCLUSIONS: The Aqueduct - 100® device can be a simple and effective alternative to perform cervical dilatation maneuvers necessary for performing gynecological procedures, intrauterine and endometrial level.

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          Mechanical methods of cervical ripening and labor induction.

          This article reviews the safety and efficacy of mechanical agents for cervical ripening. Hygroscopic dilators, balloon catheters, and devices designed for cervical ripening have all been shown to be safe and effective for cervical ripening. Mechanical agents are as efficacious as other agents for cervical ripening. However, there is no method that has been conclusively shown to improve mode of delivery or perinatal outcome. The advantages of preinduction cervical ripening with mechanical devices include low cost, low incidence of systemic side effects, and low risk of uterine hyperstimulation.
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            First trimester surgical abortion practices: a survey of National Abortion Federation members.

            The objective of this study was to survey first trimester surgical abortion practices of North American providers. A survey was mailed to the 310 active member clinics of the National Abortion Federation, the professional organization of abortion providers in North America. The 236 respondents (76%) comprising the study group provided approximately 30% and 33% of all first trimester abortions in the US and Canada, respectively. Of the 529 practitioners who perform most abortions at the clinics, 68% are obstetrician-gynecologists, and 18% are family physicians; 51% are at least 50 years old. The majority of respondents (156 of 236, 66%) confirm gestational age with ultrasonography. Of the 202 clinics that favor one method of anesthesia, 58% use local cervical block with or without oral pre-medication, 32% combine local anesthesia with intravenous sedation, and 10% use general anesthesia. Most clinics open the cervix with tapered dilators (207 of 233, 89%), evacuate the uterus by using curved rigid plastic cannulas (157 of 229, 69%) and an electric vacuum source (191 of 233, 82%), and explore the uterus with a metal curette following aspiration (133 of 232, 57%). A large majority of respondents examine the uterine aspirate on-site (91%), prescribe antibiotics (91%), and offer oral contraceptives (95%) when requested. Although variations exist, surgical techniques and postoperative practices are quite uniform among clinics. Local anesthesia is presently the most frequent method of pain control. Ultrasonographic dating before abortion is common practice. The "graying" of skilled practitioners raises concerns about the future availability of abortion.
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              Mechanical properties of the human uterine cervix: an in vivo study.

              Experimental results of in vivo measurements to characterize the mechanical behaviour of human uterine cervices are documented. Aspiration experiments were performed on eight uteri in vivo, before vaginal/abdominal hysterectomy, and four uteri were also tested ex vivo, approximately 1.5h after extraction. The reproducibility of the mechanical data from the in vivo aspiration experiments has been analysed. For an introduced "stiffness parameter" the organ specific SD is 22%, so that the proposed experimental procedure allows detections of 30% changes with respect to a reference value of the stiffness parameter. A comparison of in vivo and ex vivo data from the same organ has shown that: (i) the ex vivo mechanical response of the uterine cervix tissue does not differ considerably from that observed in vivo; (ii) some differences can be identified in tissue pre-conditioning with ex vivo showing a stronger history dependence with respect to in vivo; (iii) the differences in the time dependence of the mechanical response are not significant and might be masked by the variability of the measured data. This study represents a first step of a clinical application aiming at analysing the mechanical response of normal cervical tissue at different gestational ages, and identifying the mechanical properties that characterize pathologic conditions such as cervical insufficiency leading to preterm delivery.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                gom
                Ginecología y obstetricia de México
                Ginecol. obstet. Méx.
                Edición y Farmacia, S.A. de C.V. (Ciudad de México, Ciudad de México, Mexico )
                0300-9041
                2017
                : 85
                : 3
                : 125-133
                Affiliations
                [3] Nazaret orgnameIncubadora tecnológica NGT Israel
                [2] Sevilla orgnameHospital Universitario Virgen Macarena orgdiv1UGC de Ginecología y Obstetricia Spain
                [1] Cádiz orgnameHospital General de Santa María del Puerto orgdiv1Departamento de Ginecología Spain
                Article
                S0300-90412017000300125
                d460cbec-ce30-4c48-97d1-6f4294d68a6c

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : December 2016
                : January 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 9
                Product

                SciELO Mexico


                cuello uterino,dilatación cervical,catéter de balón,histeroscopia,legrado,Cervix,Cervical dilation,Balloon catheter,Hysteroscopy,Curettage

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