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  • Title: Nelaton catheter versus laminaria for a safe and gradual cervical dilatation.
    Author: Manabe Y, Manabe A.
    Journal: Contraception; 1981 Jul; 24(1):53-60. PubMed ID: 7273767.
    Abstract:
    During the first trimester of abortion, the Nelaton catheter can be used for the gradual, safe softening and dilatation of the cervix, just as the laminaria. Based on the results obtained from more than 1000 cases, we reached the conclusion that the effectiveness of cervical softening by the Nelaton catheter is almost equal to the laminaria and its efficiency in the dilatation of the cervix is similar or slightly inferior to the laminaria. In addition, this simple device had less risks when compared to those associated with laminaria. Therefore, the Nelaton catheter appears to be as effective as the laminaria for a safe and gradual cervical dilatation. This paper discusses the authors' experience in using the Nelaton catheter and compares the results with those of laminaria. 2070 patients with gestational ages ranging from 5 to 12 weeks were studied between the period April 1969 and October 1980 and randomly assigned to the Nelaton catheter group (n=1050) and to the laminaria or control group (n=1020). About 75% of the Nelaton group were primigravidas. The sterilized Nelaton catheter was inserted into the cervical canal usually without predilatation by metal dilators. The laminaria tents were used in the same gestational stage as with the Nelaton catheter, and without predilatation by metal dilators. Duration of catheter insertion was 24 hours for both groups. The cervix was significantly softened after application of Nelaton catheter. Resistance which occured during further cervical dilation by metal dilators after the 24-hour insertion of either device was almost equal. The Nelaton catheter had a slightly lower efficiency in cervical dilatation than the laminaria. Difficult removal of device was seen in 4% of cases using the laminaria, and none in the Nelaton group. Bleeding occured in both groups but was not serious. The findings show that the Nelaton catheter is safer than the laminaria and its efficiency is not significantly inferior to that of laminaria used in first trimester pregnancy. It is postulated that mechanical stimulation of the uterine cervix by foreign bodies such as laminaria and Nelaton catheter induces prostaglandin release from the uterus and results in the reduction of cervical stiffness. Research is now being done on the role of endogenous prostaglandins under the influence of uterine stretching.
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