Dilation and Evacuation, Late Abortion
Conditions
Brief summary
Whether intracervical block with lidocaine 1% is superior to sham procedure - intracervical injection of saline 0.9% - in terms of pain control.
Detailed description
* Research Design - Double-blind randomized study * Study Population - Women who are candidates for late termination of pregnancy by dilation and evacuation and approach for the insertion of laminaria will be recruited for the study. * The women will be divided into two groups * Research Group - Women who will undergo preparation for the insertion of laminaria by anesthesia with lidocaine spray, followed by an intracervical injection of 1% lidocaine. * Control Group - Women who will be anesthetized with lidocaine spray + intracervical injection of an inactive substance (0.9% saline). * Randomization will be performed using dedicated computer software according to blocks of 2-6 women. * All women will be offered to take 400 mg of ibuprofen about half an hour before the procedure. * In the research group - a 10 ml syringe will be filled with 7 ml of lidocaine and 1 ml of bicarbonate (total 70 mg of lidocaine). * In the control group - a 10 ml syringe will be filled with 8 ml of 0.9% NaCl saline. * Primary anesthesia will be performed using 10% lidocaine spray in up to 5 sprays. * Injection into the cervix will be performed at 3, 6, 9, 12 o'clock positions, after prior aspiration, with a 23-gauge needle, about 2 ml per point. * Laminaria type to be inserted - small diameter 3 mm, length 6.5 cm (MedGyn: Lombard, IL, USA, and Norscan: Westlake Village, CA, USA). * At weeks 18-20, 7-9 laminaria will be inserted. * Over 20 weeks - over 10 laminaria will be inserted. * Number of participants in the study - 70.
Interventions
PROCEDUREIntracervical block
local injection of lidocain to the cervix
Sponsors
Assaf-Harofeh Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 45 Years
Healthy volunteers
Yes
Inclusion criteria
* Voluntary termination of pregnancy approved by a committee or missed abortion * 18.0 to 22.5 gestational week (The gestational age in the case of a missed abortion is determined by the BPD - Biparietal Diameter, which is the determining measure for the ability to perform D&E.) * Singleton pregnancy
Exclusion criteria
* Multiple pregnancy * Women undergoing the procedure urgently due to cervical insufficiency, inevitable abortion, premature rupture of membranes, or suspected chorioamnionitis * Allergy to lidocaine * Women who do not speak Hebrew or English * Women who have a guardian for any reason * Women with a history of cesarean section * Women with abnormal placental implantation, such as placenta previa or suspected placenta accreta * Women with a psychiatric illness * Women with a history of alcoholism or drug abuse * Women who required a two-stage laminaria insertion will not be included in the analysis. In cases where the cervix does not allow the insertion of the required number of laminaria, the process is carried out in two stages: in the first stage, the maximum possible number is inserted, the woman is hospitalized, and after a few hours when some initial dilation of the cervix has occurred, the laminaria are removed and new ones are inserted according to the required number
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain level using 0-100 Visual Analog Scale (100=worst pain) | During the procedure | Patients will be asked to rate their maximal pain level during the procedure of laminaria insertion using 0-100 Visual Analog Scale |
| Rate of patient reporting severe pain (VAS 75-100) during laminaria insertion | During the procedure | Patients will be asked to rate their maximal pain level during the procedure of laminaria insertion using 0-100 Visual Analog Scale |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The rate of complications | During and immediately after the procedure | Complications during laminaria insertion: rupture of the membranes, cervical bleeding, false route; complication during dilation and evacuation - failure to complete the dilation and evacuation procedure |
| Acceptability of the procedure measured as the rate of patients who will state that they found the procedure acceptable | Immediately after the procedure | Patients will be asked to state whether they find the procedure they undergone acceptable |
Contacts
Primary ContactMatan Mor, MD
Outcome results
None listed