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.

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