Download aleaflet with product information and show it to your doctor! One or two laminaria may be used depending on how far along the pregnancy is.
By adding RGD domains the cell attachment and proliferation could be upgraded within the microarchitecture. Laminaria insertion is the beginning of the abortion process. Low temperatures reduce the diffusion rate of Ca2+ ions, which leads to slower cross-linking, a more ordered network structure and improves mechanical properties (Drury et al., 2004). 17Allen, R.H., Goldberg, A.B., (2017). Generally, by increasing the concentration of polymer, the stiffness will be increased, especially in high-MW alginates (LeRoux et al., 1999).
J Gynecol Surg; 28(6): 443. Retrieved June 2021 from USCF Health. However, it has several disadvantages such as poor mechanical properties, uncontrollable degradation, and lack of cellular interactions, which limits its biomedical applications (Masuda et al., 2003). Fetal and maternal well-being in this situation cannot be assured.19. For extremely anxious patients or if pain cannot be controlled easily, the procedure may need to be performed in the operating room.
Such information is provided for informational purposes only and is not meant to be asubstitute for advice provided by adoctor or other qualified health care professional. 4Ben-Ami, I., Stern, S., Vaknin, Z., Smorgick, N., Schneider, D., Halperin, R., (2015). Retrieved June 2021 from 36999-B Model (1) (coopersurgical.com), 2024 West Henrietta Road, Suite 6DRochester, NY 14623. After the procedure, the woman should rest for a few minutes, and can dress and go home when she feels able. Surgical Abortion: Second Trimester.
Aftercare Instructions for Medical Abortion, Aftercare Instructions for Laminaria Insertion, Aftercare Instructions for Surgical Abortions, Aftercare Information for Medical Abortion. Jonasson, A., (1984). Rupture of the Cervix During Gemeprost Middle Trimester Abortion. Figure 7.
MedGyn Products, Inc. All Rights Reserved. Saumya Das, Md Saquib Hasnain, in Alginates in Drug Delivery, 2020. Monomer composition and sequential parameters of algal alginates, Adapted from Moe, S.; Draget, K. I.; Skjk-Brk, G.; et al. Roc Mtn Med J; 72(9): 390-395. During the laminaria insertion procedure, the patient is awake and positioned for a pelvic exam. The composition and sequential structure may, however, vary according to seasonal and growth conditions.2,3 Alginates with more extreme compositions containing up to 100% mannuronate can be isolated from bacteria.4 Alginate with a very high content of guluronic acid, being of importance for the mechanical properties of the alginate gel (see below), can be prepared from special algal tissues such as the outer cortex of old stipes of L. hyperborea (see Table 1) or by enzymatic modification in vitro using mannuronan C5-epimerases from Azotobacter vinelandii5 (see below). Dilateria (Laminaria Hyperborea): Instructions for Use.
Featured products are not approved in every market, and approved labeling, indications and instructions may vary by country. Irrespective of the cross-linking method, alginate gels can keep their initial size and shape (Rowley and Mooney, 2002). Alginates are derived from brown marine algae: Macrocystis pyrifera, Laminaria hyperborea, Ascophyllum nodosum, etc. However, there are several theoretical risks.
Medical professionals, medical facility employees 855.571.2100, Need help with SupplyManager?800.422.0280, Cervical Dilator Os Finder 21.5 cm Length Teflon-Like Sterile Disposable, Cervical Dilator 60 mm Laminaria Sterile Single Patient Use, Consumers: Please visit SimplyMedical.com, Laminaria is clinically superior with larger dilation and faster results, Maximum dilation and softening normally occurs between 4 and 12 hours, The sterile, single use Os Finder naturally seeks and gently opens th , It is made of extremely smooth and malleable teflon-like material, The dilator is 21.5 cm long with a taper from 2 to 4 mm, Laminaria is clinically superior with larger dilation and faster resul .
Retrieved June 2021 from, Medisafe Distribution, Inc. Youtube Channel. 11Jonasson, A., (1984).
Most tissue types consist of more than one cell type, whose interactions may be crucial to tissue formation and regeneration (Alsberg et al., 2002). After cleansing the cervix with a povidone-iodine or chlorhexidine soaked swab, the anterior aspect is grasped with a tenaculum. However, since dilation has occurred in the cervix, the chance of infection or miscarriage is higher than normal. High bioavailability, low toxicity, lower extraction and purification cost, biocompatibility are major properties of alginate as compared with other biopolymers.
In very early pregnancies, laminaria are not necessary, but if the pregnancy is slightly more advanced, then it may be necessary to dilate the cervix more for the abortion procedure to be safe and effective. Retrieved June 2021 from WebMD. Treatment of cervical stenosis consists of dilation by using (1) progressive metal or plastic dilators, (2) osmotic dilators, (3) prostaglandin analogs, or a combination of these. We must remove the laminaria within 24 hours of insertion.
If you have doubts about proceeding with the abortion, you should not have the laminaria placed. This alginate has a characteristic guluronate (G) content of 70% and an average number of units in the G-block NG>1=11-13 . If migration or fragmentation (a piece breaks off and remains intrauterine) is suspected, a careful search of the uterine cavity must be carried out to remove it. We will remove the laminaria in 24 hours whether you decide to go ahead with the abortion or not! Christian Vogelsang, Kjetill stgaard, in Progress in Biotechnology, 1996. Contraception; 76(2): 139-56.
ScienceDirect is a registered trademark of Elsevier B.V. ScienceDirect is a registered trademark of Elsevier B.V. Family Medicine Obstetrics (Third Edition). Retrieved June 2021 fromMedisafe Distribution, Inc. Youtube Channel.
Perforation is another risk. Figure 1. The extraction of alginate from algal material is schematically illustrated in Figure 1.
All concentrations of the polymer refer to w/w relationships before geling. Commercial samples of sodium alginate from Laminaria hyperborea Protanal LF 10/60 were provided by Protan Biopolymer A/S (Drammen, Norway).
If the patient admits to having a low pain threshold or tendency to faint easily, atropine may be given prophylactically 15 to 30 minutes before laminaria placement or the aspiration procedure. It forms an ionic network in the presence of divalent or multivalent ions. Contraception; 76(6): 486-495. Sometimes more than one laminaria tent is used to obtain the desired dilation, and additional sets over 12 days may be needed in challenging cases.7 No studies currently address whether using laminaria over the course of multiple days poses greater risk of infection.8, According to WebMD, The use of laminaria [is]likely unsafewhen used to induce labor.
15Persad, M.D., Marinese, D., Osho, J., Muneyyirci-Delale, O., (2012).
One method to furnish such an adhesion is binding cellular adhesion molecules like laminin (Dhoot et al., 2004), fibronectin (Mosahebi et al., 2003), and collagen (Augst et al., 2006) to alginate but they can make nonspecific interactions.
Nevertheless, it is possible to control and characterize their biodegradation profile via oxidation process. Patients should never attempt to remove the tent on their own or pull the string. Patients who are already bleeding may request an abortion and may want tohave uterine aspiration even if a nonviable pregnancy is diagnosed or suspected. Strictly Necessary Cookie should be enabled at all times so that we can save your preferences for cookie settings. Infection is the greatest risk. ; Marcel Dekker: New York, 1995; pp 245287.1. Commercial alginates are mainly produced from Laminaria hyperborea, Macrocystis pyrifera, Laminaria digitata, Ascophyllum nodosum, Laminaria japonica, Ecklonia maxima, Lessonia nigrescens, Durvillaea antarctica, and Sargassum spp. 2Dilapan-S (2016).
Draget, in Polymer Science: A Comprehensive Reference, 2012.
Studies have shown that alginate hydrogels have multiple growth factor delivery capacity, which make the scaffold of choice for complex tissue regeneration purposes (Borselli et al., 2011; Moshaverinia et al., 2015). Consequently, alginates with a higher fraction of guluronic acid lead to stiffer gels upon ionic cross-linking.110,111 Because of the physical nature of the cross-linking reaction, gels can gradually loose their mechanical stability upon an outward flux or an alternative complexation of the cross-linking ions.
Cervical Preparation with Mifepristone Prior to Osmotic Dilators. Studies of misoprostols effectiveness in postmenopausal women are conflicting; fortunately pretreatment with vaginal estrogen for 2 weeks before dilation may augment the effect of misoprostol. This product is processed by an esterification of alginate with propylene oxide. In return the rods slowly swell and cause cervical dilation. We insert laminaria into the cervix. Alginate gels are used as cell delivery carriers in TE to provide transplanted cells in a localized site and control over their fate (Atala and Koh, 2005).
If it should fall out simply dispose of it in the trash, and notify us when you come in for the procedure. Hamilton, S., Daw, E., (1991). Laminaria in abortion: Use in 1368 patients in first trimester. It is very important for you to keep your appointment for the abortion, after laminaria insertion. Alternatively, methacrylated alginate can be synthesized by esterification of the hydroxyl groups using anhydrides such as methacrylic anhydride113 (see Figure 7). The entire procedure takes about 10 minutes. Usually, G-rich alginate is more powerful than M-rich alginate (Kandalam et al., 2012). Matthew K. Cline MD, James M. Nicholson MD, MSCE, in Family Medicine Obstetrics (Third Edition), 2008. Rupture of the Cervix During Gemeprost Middle Trimester Abortion. Since alginate is insoluble within the algae with a counterion composition determined by the ion-exchange equilibrium with seawater, the first step in alginate production is an ion exchange with protons by extracting the milled algal tissue with mineral acid.
Cervical dilatation is an unpleasant procedure; cervical priming prior to operative procedures not only improves the tolerance but also facilitates the operation and reduces the risk of cervical injury and uterine perforation. Injection of dilute vasopressin (0.05 U/mL) into the cervical stroma has also been found to decrease the force needed to dilate the cervix (Phillips, 1997). The ratio between manuronic and guluronic acid blocks and their sequential distribution of homogeneous (MM segments and GG segments) and alternating segments are very dependent on the source of the alginate as well as on seasonal and geographical variations. The fibronectin-derived adhesion peptide arginine-glycine-aspartic acid (RGD) is commonly used (Ruoslahti, 1996).
Laminariaa modern cervix dilatation method with more than a 100-year history. The chemical structure of alginates comprises 1,4-linked -d-mannuronic acid (M) as well as 1,4 -l-guluronic acid (G) residues, which are positioned in heterogeneous (MG) or homogenous block patterns . Na-alginate (most common), and potassium and ammonium salts are manufactured. Using a sponge or uterine packing forceps, a laminaria of appropriate size is inserted so that the tip rests against the internal os. Cervical dilation before first-trimester surgical abortion (<14 weeks gestation).
021002 #2mm Laminaria Extra Small Extra Thin (25/Box), 021003 #3mm Laminaria Small (25/Box), 021004 #4mm Laminaria Medium (25/Box), 021005 #5mm Laminaria Large/Thick (25/Box), 021006 #6mm Laminaria Extra Large Extra Thick (25/Box), 021008 #8mm Laminaria Jumbo (25/Box), 021010 #10mm Laminaria Extra Jumbo (25/Box), 021014 #4mm, Laminaria Long (25/Box), 021015 #5mm, Laminaria Long (25/Box), 021016 #6mm, Laminaria Long (25/Box), 021018 #8mm, Laminaria Long (25/Box), 021022 #2mm Laminaria Extra Small w/button (12/Pack), 021023 #3mm Laminaria Small w/button (12/Pack), 021024 #4mm Laminaria Medium w/button (12/Pack), 021025 #5mm Laminaria Large w/button (12/Pack), 021026 #6mm Laminaria Extra Large w/button (12/Pack), 021003L #3mm Laminaria Small Long String (25/Box), 021004L #4mm Laminaria Medium Long String (25/Box), 021005L #5mm Laminaria Large/Thick Long String (25/Box), 021006L #6mm Laminaria Extra Large Extra Thick Long String (25/Box), 021008L #8mm Laminaria Jumbo Long String (25/Box), We offer a full range of high-quality obstetric and gynecology products including equipment, disposables and instruments to meet the needs of healthcare professionals worldwide, 100 West Industrial Rd Addison, The risk of intra-amniotic infection, inflammation and histologic chorioamnionitis in term pregnant women with intact membranes and labor. 13Gusdon, J.P., Jr, May, W.J., (1975). Alginate hydrogel can serve as a scaffold for bone TE. Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care.
The addition of cationic poly(ethyleneimine) (PEI) to alginate can ameliorate its mechanical properties (Kong and Mooney, 2003). This means that every time you visit this website you will need to enable or disable cookies again. - More information, You are entering page, which contains information intended only for health care personnel. Symptoms include bleeding, cramping, and passage of tissue. Ehsan Zahedi, Alireza Moshaverinia, in Biomaterials for Oral and Dental Tissue Engineering, 2017. Manoj Kumar Sarangi, Sitansu Sekhar Nanda, in Natural Polysaccharides in Drug Delivery and Biomedical Applications, 2019. M and G blocks proportion: Ascophyllum nodosum and Laminaria digitata, extracted alginate, with M/G ratios of 1.82and 1.16, respectively . All chemicals used were of analytical quality and the water used in all experiments was deionized by Milli-Q equipment (Millipore Corporation, Bedford, Mass., USA), unless otherwise stated. This is not usually a problem. 12Hamilton, S., Daw, E., (1991). There they swell gently in the moist environment, dilating the cervix. Various favorable characteristic features such as water solubility, high biodegradability, good biocompatibility, and gel formation ability make the alginates as biopolysaccharidic excipients in the designing of conventional as well as modified drug releasing dosage forms . Since alginate gels do not promote cell attachment, they have to be covalently modified to provide significant attachment (Lansdown and Payne, 1994). Laminaria in abortion: Use in 1368 patients in first trimester.
If laminaria have been placed they may fall out, migrate up into the uterus, or fragment. Occasionally the laminaria and sponge may fall out during the night. 1. M. Henke, A. Gpferich, in Polymer Science: A Comprehensive Reference, 2012.
Ltd. 9WebMD, LLC (2021). Their applications as cell transplantation vehicles, drug delivery systems, and scaffold are discussed in this section.
It is not intended to provide medical advice or replace care from a qualified medical practitioner. Some patients may experience avasovagal reaction during laminaria placement or at other times during or after the procedure. Alginates are comprised of a sequence of -d-mannuronate (M)monomers and two (14)-linked-l-guluronate(G).
6UCSF Medical Center (2021). We recommend that you view the laminaria insertion as the beginning of the abortion. Clinicians now also use misoprostol for softening and dilating the cervix. Laminaria have been in use for many years and the risks are very low.
Proliferation and/or tissue growth (Richmon et al., 2005), and vascularization (Schumacher et al., 1998). You should always consult with adoctor or other health care professional. Marine polysaccharide, extracted from brown seaweeds like Ascophyllum nodosum, Laminaria hyperborea, Laminaria digitata, Laminaria japonica, and Macrocystis pyrifera  are known as alginates. A chemically modified alginate is currently used clinically to deliver proteins with the purpose of promoting regeneration of mineralized tissue (Bratthall et al., 2001) and as a vehicle for transplanted cells (Augst et al., 2006). Copyright 2022 Elsevier B.V. or its licensors or contributors. You should not use the information contained herein for diagnosing ahealth or fitness problem or disease. Steady pressure placed on the cervix by the tent also promotes the release of endogenous prostaglandins, causing contractions2 which readies the body for expulsion of the fetus. However, the patient must be warned of the risk of miscarriage. Alginates are linear unbranched polysaccharides isolated from brown algae such as laminaria hyperborea and lessiona consisting of variable amounts of -d-manuronic acid and its C5-epimer -l-guluronic acid linked via -1,4-glycosidic bonds.
Itactsas a stabilizer agent and as an excipient in DDSs in pharmaceutical formulations. Modern means of diagnosing miscarriage in the first trimester include transvaginal ultrasonography and serial quantitative hCG determinations. If the laminaria is in place for over 24 hours, infection is a real possibility.
Next, the alginic acid is brought into solution by neutralization with alkali.
Roc Mtn Med J; 72(9): 390-395. In these cases, additional studies, such as ultrasonography and serial quantitative -human chorionic gonadotropin (hCG) determinations, are indicated. The plants stem is dried and sized to auniform diameter. Introducing the Dilapan-S, fast-acting osmotic cervical dilator. The traditional drug delivery systems are poor in targeting the tissue of interest, which can lead to side effects and low effectiveness (Mazu et al., 1993). If the cramping is bothersome, you may take Advil, Motrin, or Tylenol. Many women feel nothing at all.
As a biomaterial, alginate has a number of advantageous features including biocompatibility and nonimmunogenicity and they are likely related to its hydrophilicity (Shapiro and Cohen, 1997). RGDalginate gels significantly enhance bone formation in vivo by transplanted calvarial osteoblasts (Alsberg et al., 2001).
Retrieved June 2021 from U.S. National Library of Medicine, Clinical Trials.gov.
Osmotic dilators are more effective than prostaglandins for priming the cervix, but a combination of the two is also very effective. These are also rods, but made from aseaweed called Laminaria Japonica, anatural plant from Northern Asia. 3Allen, R.H., Goldberg, A.B., (2017). Placenta; 32(7): 516-521. This means that the procedure itself is quicker and easier.
The only derivative of alginates today having a commercial value is the propylene glycol alginate (PGA). Growth factors can foster or hinder cell differentiation (Li et al., 2006). do not delete this button, visible only in admin. They are anatural product, which may increase the risk of infection. This site is not intended for Czech non-healthcare professionals.
Laminaria also provides agradual dilation by absorbing natural uterine moisture.
If youre considering a second-trimester abortion and want to know more about your abortion options, schedule a free consultation with us today. Alginates have been found to be used for topical delivery of several drugs and in the drug delivery for tissue engineering applications . We typically place laminaria for pregnancies greater than ten weeks in duration.
Atropine may be administered for treatment and prevention (0.4 mg IV or subcutaneously); the patients legs should be elevated and her head lowered. Advanced gestational age can become a complication if the practitioner initiates a procedure that is beyond his or her training or clinical setting because of inaccurate gestational age dating based on the misinterpretation of ultrasonographic or bimanual examination findings.
Some type of short amino acid sequences that are present in ECM molecules can provide such an adhesion instead. Reference the Instructions for Use for acomplete listing of indications, warnings and precautions, Cookies help us deliver our services. Laminariaa modern cervix dilatation method with more than a 100-year history. J Obstet Gynaecol;11(4): 295.
Jordemodern; 97(6): 187-195. Although misoprostol is most effective on the pregnant uterus and very small doses are often all that is needed, efficacy has been shown in nonpregnant uteri, especially in women of reproductive age. IL 60101 USA.
Laminaria is a 100% natural cervical dilator made from a sea-grown plant containing no synthetic materials. Laminaria is used mainly in second-trimester abortions (D&E).
Similarly, amniotic membrane stripping has not been determined to provide a clear-cut improvement in cervical Bishop's score, although it does reduce the average gestational age of labor onset.31 Two methods of treatment that currently are under investigation include the use of acupuncture30 and the use of isosorbide mononitrate. Agents commonly used for this purpose include osmotic dilators (e.g., laminaria sticks or tents, synthetic osmotic dilators) and various prostaglandin preparations. Alginates are polysaccharides isolated from brown algae such as laminaria hyperborea and lessonia found in coastal waters around the globe. Alternatively, atropine may be added to the paracervical block. Alginate hydrogels could be widely useful for the sustained and localized delivery of traditional low-MW drugs and macromolecules for tissue regeneration.
Cervical dilation before first-trimester surgical abortion (<14 weeks gestation).
The exact mechanisms that control this process are still poorly understood but may be linked to differential adhesion or response to chemotactic gradients. Gelling conditions and type of cross-linker can alter mechanical properties.
Laminaria should not be left in place for over 24 hours due to increased risk of infection and other complications.
Although a Cochrane review (Tangsiriwatthana, 2013) found that women had less pain with cervical dilation and uterine instrumentation following a paracervical block than with placebo injection, the investigators found that clinically this may be unimportant. Guluronic acid blocks of adjacent polymer chains can be cross-linked with multivalent cations such as Ca2+ and Ba2+ interacting with the carboxyl groups in the polymer backbone leading to the formation of gel networks.