Mechanical dilation to remove incarcerated laminaria during a second trimester abortion

Area of Science:

• Medical procedures
• Gynecology
• Surgical abortion

Background:

• Cervical preparation with laminaria is a common method to reduce complications during second-trimester dilation and evacuation procedures.
• Laminaria, osmotic dilators, are used to gradually open the cervix before surgical abortion.

Observation:

• During a 22-week surgical abortion, laminaria became incarcerated and could not be removed manually or with ring forceps.
• The laminaria exhibited a "dumbbell" shape, indicating significant swelling and potential impaction within the cervix.

Findings:

• Mechanical cervical dilation was employed to release the incarcerated laminaria without advancing it into the uterus.
• Successful removal of the impacted laminaria was achieved through mechanical dilation.

Implications:

• This case highlights a potential complication of laminaria use: "dumbbell" incarceration.
• Mechanical cervical dilation can be an effective technique for managing incarcerated laminaria during dilation and evacuation procedures.
• Further research may be needed to explore methods for preventing or managing laminaria incarceration.