Clinician to Clinician: Easing D&C in the stenotic cervix
Cervical stenosis can complicate a D&C by creating a false passage in the cervical canal, and possibly lead to uterine perforation. I've found that insufflation with 32% dextrin 70 in dextrose can ease the stenosis, as illustrated by the case described below.
In 2002, I saw a 71-year-old P2, LNMP 1981 who complained of intermittent vaginal staining for the past few months. Her pelvic exam was within normal limits. I was able to place a tenaculum on the anterior lip but could not get a Pipelle cannula into her os because of cervical stenosis.
The patient subsequently was admitted to the hospital for a D&C. Once again, it was not possible to pass a uterine sound into the os. The distal portion of the endocervical canal was serially dilated with Hank dilators until the hysteroscope could be placed into the os. I then insufflated 10 to 15 mL of 32% dextrin 70 in dextrose.
CLINICIAN TO CLINICIAN offers the hard-won wisdom and expertise of physicians "in the trenches." We're looking for unusual case reports, anecdotes about innovative treatments, and practical solutions for professional problems from community physicians. Send your submission of 750 words or less to Editor in Chief Charles J. Lockwood, MD, by e-mail (Dr.Lockwood@advanstar.com
) fax (973-847-5340) or mail (5 Paragon Drive, Montvale, NJ 07645). All submissions are subject to peer review by the Contemporary OB/GYN Editorial Board. Nevertheless, the concepts discussed may be anecdotal in nature.
