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A laminaria stick or tent is a thin rod made of the stems of dried laminaria, a genus of kelp. Laminaria sticks can be generated from Laminaria japonica and Laminaria digitata.

Use in obstetrics and gynecology
Laminaria are used as osmotic dilators to aid in dilating the cervix prior to surgical abortion in some pregnancy terminations in the second trimeter. Adequate dilation of the cervix is important prior to surgical abortions because it helps to prevent complications of D&E, such as laceration of the cervix. Dilation of the cervix can be accomplished with mechanical dilators, such as laminaria, or with medications including prostaglandins and/or mifepristone. However, there is no consensus as to which cervical preparation method is superior in terms of safety and technical ease of the procedure.

At later gestational ages, osmotic dilators, including laminaria, may be used to assist in dilating the cervix. Most abortion providers use laminaria, Dilapan, or both for osmotic dilation prior to surgical abortion after 18 weeks gestation. Osmotic dilators, including laminaria tents, may be used at earlier gestations as well.

Mechanism of action
The laminaria tents are usually left in place overnight and may even be left in place for 2 days.

Removal

Laminaria are removed prior to initiating the D&E, after they have started the process of dilating the cervix. The cervix may be dilated further using mechanical dilators.

Laminaria function by absorbing fluid from the cervix, expanding, and exerting radial pressure on the cervix. They also cause the release of prostaglandins.

Placement
Prior to a planned surgical abortion, laminaria may be inserted into a woman's cervix. A speculum is placed in the vagina to allow the provider to see the uterine cervix. The laminaria can then be placed through the cervix. Over time, the laminaria tents absorb fluid and swell to 3-4 times their initial diameter. Most of the increase in size occurs within 6 hours after the laminaria are placed in the cervix, though further expansion will continue over 12-24 hours. The number of laminaria tents placed depends on the gestational age of the pregnancy as well as on if the patient has had prior vaginal deliveries. More laminaria are generally used with advancing gestational age.

The laminaria tents are usually left in place overnight.

Removal
Laminaria are removed prior to initiating the D&E, after they have started the process of dilating the cervix. The cervix may be dilated further using mechanical dilators.

Risks
Risks of laminaria stick insertion include pain, rupture of amniotic membranes and/or initiation of labor, and infection in very rare cases.

Cervical preparation
Prior to D&E, the cervix must be dilated sufficiently to allow the surgeon to pass surgical instruments through the cervix without causing injury to the cervix. At later gestational ages, patients may require a two day procedure with cervical preparation occurring the day prior to the D&E. Adequate dilation of the cervix is important prior to surgical abortions because it helps to prevent complications of D&E, such as laceration of the cervix. Dilation of the cervix can be accomplished with osmotic dilators, with adjunctive medications such as misoprostol or mifepristone, or a combination of these methods. There is no consensus as to which cervical preparation method is superior in terms of safety and technical ease of the procedure.



Anesthesia options
Local anesthetics, such as lidocaine, are frequently injected near the cervix to reduce pain during the procedure. IV sedation may also be used. General anesthesia is usually not necessary.

Infection prophylaxis
Immediately prior to the procedure, antibiotics are usually administered to prevent infection.

Surgical Procedure
A speculum is placed in the vagina to allow visualization of the cervix. If osmotic dilators were placed prior to the procedure, these are removed.

The cervix may be further dilated with dilators. Sufficient cervical dilation decreases the risk of morbidity, including cervical injury and uterine perforation. The procedure may be performed under ultrasound guidance to aid in visualizing uterine anatomy and ensuring that all tissue has been removed at the completion of the procedure. The pregnancy tissue including all fetal parts and placental tissue is removed using a combination suction curettage and surgical instruments called forceps.

Recovery
Most patients return to home the same day as the procedure.

Risks of D&E
D&E is a safe procedure when performed by experienced practitioners. The rate of mortality following legal in the US is 0.62 legal induced abortion-related deaths per 100,000 reported legal abortions. The strongest risk factor for mortality following abortion is increasing gestational age.

Risks of D&E include bleeding, infection, uterine perforation, and damage to surrounding organs or tissues. Hemorrhage occurs following less than 1% of all surgical abortions. Infection rates following second trimester abortion have been reported to be 0.1-4%. The risk of infection is decreased by the use of antibiotics. Rare risks of D&E include uterine perforation, retained products of conception, and rare risk of hysterectomy.

There is no evidence that surgical abortion causes in increase in infertility or adverse outcomes in subsequent pregnancies

Alternatives to D&E

 * Labor induction abortion
 * Pregnancy continuation