U.S. patent number 3,848,602 [Application Number 05/245,310] was granted by the patent office on 1974-11-19 for abortion facilitating device and process.
Invention is credited to Morton Gutnick.
United States Patent |
3,848,602 |
Gutnick |
November 19, 1974 |
ABORTION FACILITATING DEVICE AND PROCESS
Abstract
A process for cervical dilation prior to the performance of an
abortion comprising the steps of inserting an abortion facilitator
unit through the cervix and extending into the uterine cavity,
gradually, uniformly radially expanding the portion of the dilator
adjacent to the cervix at a controlled rate to dilate the cervix by
introduction of a fluid, removing the fluid once the cervix has
been dilated, removing the dilating unit, and completing the
abortion. Apparatus for cervical dilation comprising a shaft member
having three conduits extending therethrough, one conduit
terminating substantially inboard the distal end and communicating
with a dilating section of substantially cylindrical configuration
when expanded, a second conduit terminating distal of said first
conduit and terminating in an expandable anchoring member, and said
third conduit terminating proximate the tip of said shaft member
for permitting ingress and egress of fluids to the uterine
cavity.
Inventors: |
Gutnick; Morton (Elkins Park,
PA) |
Family
ID: |
22926151 |
Appl.
No.: |
05/245,310 |
Filed: |
April 19, 1972 |
Current U.S.
Class: |
606/193; 604/104;
604/919; 604/913; 604/101.05 |
Current CPC
Class: |
A61B
17/42 (20130101); A61M 25/1011 (20130101); A61M
29/02 (20130101); A61M 2025/1093 (20130101) |
Current International
Class: |
A61B
17/42 (20060101); A61M 25/10 (20060101); A61M
29/02 (20060101); A61m 029/00 () |
Field of
Search: |
;128/341,343,344,345,348,351,246,276,130,129,131,2R,1R |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Truluck; Dalton L.
Attorney, Agent or Firm: Bramson; Robert S. Drobile; James
A.
Claims
What is claimed is:
1. A process for performing an abortion to a uterus containing at
least one human fetus during approximately the first 24 weeks of
pregnancy, comprising steps of:
a. Inserting into the undilated cervix a radially expandable
dilating member which is substantially coextensive therewith;
b. Substantially radially uniformly and gradually enlarging the
expandable portion of said dilating member by the introduction
therein of a fluid until the cervix is dilated an amount in the
range from about 1.5 cm. to about 4 cm.;
c. Exhausting said dilating member; and
d. Removing said dilating member from the cervix.
2. A process for performing an abortion to a uterus containing at
least one human fetus during approximately the first 24 weeks of
pregnancy, comprising the steps of:
a. Inserting substantially into the uterine cavity an abortion
facilitating device extending from the vagina into the uterine
cavity and comprising a radially expandable cervical dilating
member and an expandable foreign body member;
b. Seating in the undilated cervix the radially expandable dilating
member and seating in the uterus the foreign body member;
c. Expanding the foreign body in the uterus;
d. Substantially radially uniformly and gradually enlarging the
expandable dilating member until the cervix is dilated an amount in
the range from about 1.5 cm. to about 4 cm.;
e. Exhausting said dilating member and said foreign body member;
and
f. Removing said abortion facilitating device from the uterus.
3. A process as set forth in claim 2, wherein said enlarging of
said dilating member occurs during a period of up to about four
hours.
4. A process for performing an abortion to a uterus containing at
least one human fetus during approximately the first 24 weeks of
pregnancy, comprising the steps of:
a. Inserting substantially into the uterine cavity an abortion
facilitating device and simultaneously seating in the substantially
undilated cervix a radially expandable dilating member;
b. Substantially radially uniformly and gradually enlarging the
expandable portion of said dilating member during a period of up to
about 4 hours until the cervix is dilated an amount in the range
from about 1.5 cm. to about 4 cm.;
c. Exhausting said dilating member; and
d. Removing said abortion facilitating device from the uterus.
5. A process as set forth in claim 4, including the final step of
inserting an aborting device into the uterus to complete the
abortion.
6. A process as set forth in claim 5, including the step, after
insertion of the abortion facilitating device into the uterus, and
prior to expansion of the dilating member, of relatively fixedly
immobilizing said abortion facilitating device with respect to the
cervix by expanding an anchoring member of said device within the
uterus.
7. A process as set forth in claim 4 including the step of allowing
the expanded dilating member to remain in the cervix for at least
several hours prior to removal of the abortion facilitating
device.
8. A process as set forth in claim 4, including the step of
introducing medication directly into the uterus through the portion
of said device extending into the uterine cavity.
9. Apparatus for cervical dilation for and facilitation of an
abortion, comprising:
a. An elongated, firm, flexible shaft member having a proximal end
and a distal end and defining at least two conduits commencing
proximate its proximal end;
b. An expandable peripheral dilating member integral with said
shaft member and having a length in the range from about 5 cm. to
about 6 cm., said dilating member having a transverse dimension in
the unexpanded condition of approximately the same size as the
transverse dimension of the remainder of the shaft;
c. Said dilating member when inserted in the cervix of a human up
to about 24 weeks pregnant being expandable in the cervix
substantially in the form of a cylinder with rounded ends in the
fully expanded condition and in all partially expanded conditions
and having a transverse dimension in the expanded condition in the
range from about 1.5 cm. to about 4 cm.;
d. An expandable peripheral anchoring member integral with said
shaft member formed on the distal side of the dilating member and
spaced at least in the range from about 2 cm. to about 6 cm.
therefrom, and having a fully expanded transverse dimension which
is approximately equal to the expanded dimension of the dilating
member; and
e. One of said two conduits communicating with the interior of said
dilating member and the other of said two conduits communicating
with the interior of said anchoring member.
10. Apparatus as set forth in claim 9, wherein said dilating means
includes an inflatable wall having a fabric scrim substantially
incorporated therein.
11. Apparatus as set forth in claim 9, wherein said shaft member
defines a third conduit extending from a point proximate the
proximal end thereof to a point proximate the distal end thereof,
said third conduit communicating with the surface of said unit
proximate the distal end thereof, whereby fluid can be drained from
the uterus or introduced into the uterus through said third
conduit.
12. Apparatus as set forth in claim 9, including a stop member
formed on said shaft member proximate and spaced about 1 cm. from
the proximal end of said dilating member, and extending transverse
to said shaft member and defining at least one aperture extending
axially through said stop member to permit the affixation of said
member in situ.
13. Apparatus as set forth in claim 9, wherein said shaft member
has a rounded distal end and the proximal end terminates in three
separate, spaced conduits.
14. Apparatus as set forth in claim 9, wherein said shaft member is
formed of a sterilizable, smooth material.
15. Apparatus as set forth in claim 9, wherein the proximal end of
each of said two conduits is closed by a resealable membrane.
16. Apparatus as set forth in claim 9, wherein said expandable
anchoring member has a proximal end and said dilating member has a
distal end and wherein the spacing therebetween is in the range
from about 1 cm. to about 2 cm.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The invention relates to a cervical dilating apparatus and process
for performing an abortion which has the effects of dilating the
cervix and facilitating, and, on some occasions, spontaneously
initiating an abortion.
2. State of the Art
Although cervical dilators have been suggested for use in dilating
the cervix to facilitate labor during full-term birth, as disclosed
in U.S. Pat. 3,480,017, satisfactory techniques and apparatus for
dilating the cervix atraumatically prior to performing an abortion
have not been developed, and no apparatus or process has been
disclosed for generally facilitating and, on some occasions,
spontaneously inducing an abortion.
In performing abortions by the technique in which dilation of the
cervix is necessary to permit introduction of a vacuum device to
accomplish the abortion, dilation of the cervix was previously
accomplished by the use of steel dilators, which were manipulated
in such a way as to stretch and stimulate the cervix to cause it
relatively rapidly to dilate to the necessary degree to permit the
abortion. The extent to which cervical dilation is required depends
upon the stage of the pregnancy, ranging from approximately 10 mm.
for a pregnancy at approximately the fifth or sixth week of its
progress to approximately 14 mm. for a pregnancy which is in the
third or fourth month of its progress. This manipulation of the
cervix with steel dilators could, and frequently does, cause
tearing and laceration of the cervix, occasionally resulting in
severe lacerations of the cervix, often needed to be closed by
suturing, and also could and occasionally does result in the much
more serious incident of the perforation of the uterus.
Moreover, prior to this invention, there has been no apparatus or
process known for use in inducing abortions in advanced
pregnancies, on the order of 17 weeks, to accelerate the period
after injection of hypertonic saline and prior to miscarriage and
sometimes to induce miscarriage without the injection of hypertonic
saline.
BRIEF SUMMARY OF THE INVENTION
The process of the invention comprises the insertion of the
dilation device of the invention into and through the cervix, so
that the distal end thereto extends into the lower segment of the
uterine cavity, expansion of an anchoring member by introduction of
fluid thereinto, to prevent accidental dislodging of the dilation
device, and uniform and gradual radial expansion of the dilating
member which occupies the entire length of the cervix, up to a
transverse dimension of between about 1.5 cm. and 4 cm. or more,
depending upon the stage of the pregnancy of the patient being
treated. When the maximum desired degree of dilation has been
achieved, which will desirably be achieved in four or more hours,
the abortion facilitator may be allowed to reside in place for a
substantial period of time, preferably overnight. When it is time
to complete the abortion, if it has not occurred spontaneously, the
dilating member is deflated to its normal dimension which is almost
the same as the transverse dimension of the shaft member body per
se, the anchor member is also deflated to its normal dimension, and
the abortion facilitating device is removed. During the presence of
the dilating device in situ, fluid can be removed from the uterine
cavity or introduced thereinto through a conduit which communicates
the proximal end of the shaft member, which extends outside the
patient's vagina during the dilation procedure with the distal end
thereof which is located within the patient's uterus.
During the residence in utero of the abortion facilitator device of
this invention, the "pregnancy" is disrupted by the distal segment
of the device and by the expansion of the anchoring member, and
this tends to stimulate a spontaneous abortion due to the presence
of a foreign body in the uterus.
The abortion facilitator apparatus of the invention comprises a
thin, elongated shaft member, having a rounded distal end and a
proximal end which preferably terminates in three separate
conduits, each of which communicates with a distinct channel
defined within the shaft member per se. One channel communicates
with the dilating member of the shaft member, which is spaced a
substantial distance from the distal end of the shaft member. The
dilating member, in the deflated state, is of substantially the
same dimensions and cross-section as the shaft member body per se,
and in the inflated state is of substantially cylindrical shape and
has a transverse dimension of from about 1.5 cm. to about 4 cm.,
and a length of from about 5 cm. to about 6 cm. In the expanded
condition and in the expanding condition, the dilating member
maintains the substantially cylindrical configuration, with rounded
ends, so that, as it expands, the dilating member applies uniform
pressure to the cervical os which surrounds it.
Spaced distally of the dilation member, a distance of about 1 cm.
to about 1.5 cm., is an anchoring member, which extends into the
uterus, and prior to inflation is of the same transverse dimension
as the shaft member body per se. The anchoring member, as it is
inserted in the uterus acts as a foreign body (with the tip of the
abortion facilitator) and as it expands will disrupt the pregnancy,
thereby stimulating the uterus to expel the foreign body and, on
some occasions, to induce a spontaneous abortion. The anchoring
member is supplied with fluid from a separate conduit formed in the
shaft member body, and expands to a transverse dimension
approximately equal to the expanded transverse dimension of the
dilating member. It is inflated, in use, prior to inflation of the
dilating member, and serves to anchor the cervical dilator unit in
situ. In its expanded condition the diameter of the anchoring
member is approximately equal to the diameter of the dilating
member. Therefore, if spontaneous abortion occurs, the anchoring
member will not interfere with the natural expulsion of the
abortion facilitator, since its diameter will be equal to the
dilated opening of the cervix.
Spaced from and proximate the proximal end of the dilating member
is a pair of wings, extending transversely in the body of the shaft
member, and having an aperture in each of the wings. The wings
function to assist in the location of the shaft member with the
cervical dilating member properly located within the cervix, and
the apertures in the wings facilitate temporary suturing of the
shaft member in place, and allow passage of a tenaculum through the
opening in each wing.
The proximal end of the shaft member terminates in three distinct
conduits, one for supplying an inflating fluid to each of the
respective dilating and anchoring members, and one leading to a
main channel which is internal to the body of the shaft member and
extends therethrough to a point proximate the rounded tip at the
distal end thereof. This latter channel permits drainage of fluid
from the uterus and the introduction of medication into the uterus.
Each of the two conduits leading to the respective anchoring and
dilating members may be equipped, and preferably is equipped at its
proximal end with a suitable valve device, to permit the attachment
of a member or means for introducing fluid to the two expandable
member conduits. The conduit connecting to the main channel, for
introducing to or removing fluid from the uterus is preferably left
open, and fluid or medication can be introduced into the uterine
cavity by an irrigating-aspirating syringe, for example.
In the preferred form of the invention, the abortion facilitating
device of the invention is produced in a number of different sizes,
having somewhat different dimensions for use with women in
different stages of pregnancy. Each abortion facilitator unit is
preferably formed of a medically acceptable, firm but flexible
material, and is also preferably packaged in a sterile package for
one-time use and disposal.
OBJECTS OF THE INVENTION
It is therefore an object of this invention to provide a process
for the atraumatic and relatively safe dilation of the cervix of a
patient as a preliminary step to the performance of an abortion and
including the insertion of a foreign body into the uterus to tend
to stimulate spontaneous abortion.
Another object of this invention is to provide a process for the
pre-abortion dilation of the cervix by slowly and gradually, at a
controlled rate, expanding the walls of the cervix under the
pressure of the dilating member of the invention.
Yet another object of the invention is to provide a dilating
apparatus, for use prior to an abortion procedure, and comprising a
dilating member for uniformly radially gradually dilating the
cervix, relatively painlessly and without damaging the cervix or
the uterus.
A concomitant object of this invention is to provide a cervical
dilating apparatus including means obtruding into the cervix to act
as a foreign body, to disrupt the pregnancy and to anchor the
abortion facilitating apparatus in place during use, to prevent
inadvertent displacement thereof during use, and further including
means for facilitating drainage of liquid from the uterus and
introduction of liquid into the uterus.
An attendant object of this invention is to provide a cervical
dilation apparatus which can be produced in different sizes, for
optimal use in performing abortions in persons at different stages
of pregnancy.
A still further object of this invention is to provide an apparatus
which may easily be inserted into the cervical os and uterine
cavity atraumatically and with a minimum of discomfort and pain to
the patient.
A still further object of this invention is to provide an apparatus
for cervical dilation that will also stimulate the lower uterine
segment and make the uterus more responsive to oxytocics, thereby
inducing rapid miscarriage in pregnancies of 17 weeks and greater
duration, and on occasion in such late pregnancies stimulate
spontaneous abortion without the need of oxytocics.
DESCRIPTION OF THE DRAWINGS
FIG. 1 is a fragmentary front elevational view of the apparatus of
this invention, packaged in a sterile package prior to use;
FIG. 2 is a fragmentary front elevational view of the apparatus of
this invention, in the fully expanded condition;
FIG. 3 is a cross-sectional view taken along line 3--3 of FIG.
2;
FIG. 4 is a cross-sectional view taken along line 4--4 of FIG.
2;
FIG. 5 is a cross-sectional view taken along line 5--5 of FIG. 2;
and
FIG. 6 is a schematic representation of a uterus showing the
operative end of the apparatus of the invention in place in the
expanded condition.
DETAILED DESCRIPTION OF THE INVENTION
Viewing FIG. 2, the abortion facilitator unit of this invention,
generally designated by the numeral 8, is seen to comprise a shaft
member, generally designated as 10, having an elongated body,
formed of medically acceptable, sterilizable, firm, flexible
material, more fully described hereinafter, and terminating at its
distal end in a rounded tip 12 and at its proximal end in three
discrete conduits, respectively designated 14, 16 and 18. The
conduits 14, 16 and 18 are integrally formed with and connected to
the shaft member member 10 at its proximal end 20. The shaft member
member 10, between its proximal end 20 and extending toward its
distal end 12, defines three discrete channels, respectively
designated 24, 26 and 28, best seen in FIG. 4. The longest channel,
channel 28, extends from the proximal end of the shaft member,
where it is in fluid communication with conduit 18, to a point
spaced proximate the distal end 12 of the shaft member where
channel 28 communicates with a plurality of apertures 30 which
extend to the surface of the shaft member 12, and which permit
fluid flow from the ambient at the distal end of the shaft member,
into channel 28 and therefrom into conduit 18, and exiting through
the proximal end 38 of conduit 18.
It may be desired, to avoid any confusion, to label each of the
conduits 14, 16 and 18 with some identifying language indicating
the particular communication which each provides, such as by
labelling conduit 14 "anchor," conduit 16 "dilator," and conduit 18
"uterine."
Channel 24 extends to a point spaced inwardly from the distal end
12 of the catheter and is in fluid communication, via a transverse
channel 34, seen in FIG. 3, wth the inflatable anchor section or
member 44 of the catheter. Anchor section 44 is shown in the
deflated condition in FIG. 1 and in the inflated condition in FIGS.
2 and 6. Anchor member 44 comprises a thin, expandable, peripheral
membrane, like a balloon, formed at the outer surface of shaft
member member 10, and having substantially the same cross-sectional
size and configuration as the remainder of the body of the catheter
12 when in the deflated condition shown in FIG. 1. Upon
introduction of fluid, through conduit 14, into channel 24, and
through channel 34 to anchor member 44, the anchor member 44 is
inflated to the squat toroidal configuration shown in FIG. 2, in
which the anchor member 44 preferably has a maximum diameter in the
range from about 1.5 to about 4 cm., approximately equal to the
inflated diameter of the dilating member 46; different sizes of
abortion facilitators will have different maximum diameters,
depending upon the stage of pregnancy for which the device of this
invention is to be used.
Also formed at the outer periphery of the shaft member body 10, is
an inflatable dilating member 46. Dilating member 46 comprises a
thin, expandable peripheral membrane, like a balloon, which, when
in the deflated condition shown in FIG. 1, has a cross-section
approximately equal to the cross-section of the shaft member body,
and, when in the inflated condition, has the substantially
cylindrical shape, with rounded ends, illustrated in FIG. 2. The
dilating member 46 is in fluid communication with channel 26,
through a transverse channel 36 in the body of the shaft member 10,
to allow the dilating member to be inflated, by the introduction of
fluid through conduit 16, into channel 26, and therefrom through
transverse channel 36 into the dilating member 46. The upper end of
dilating member 46 is spaced below the lower end of anchor member
44 a distance of about 1.0 cm. to about 1.5 cm., for purposes more
fully to be described hereinafter.
The dimensions of dilating member 46 may be varied, in accordance
with the stage of pregnancy of the patient whose cervix is being
dilated, and the dimensional differences will also be more fully
described hereinafter. However, in one embodiment of the invention,
usable for patients during the sixth to twelfth week of pregnancy,
the dilating member 46, in the expanded condition, will have a
diameter of approximately 3 cm. and a longitudinal dimension of
approximately 6 cm. The construction of the dilating member 46 is
such that the longitudinal portions of the outer wall 48 of the
dilating member are approximately parallel, and remain
approximately parallel as the dilating member expands from the
deflated condition of FIG. 1 to the inflated condition of FIG.
2.
Formed inboard the proximal end of dilating member 46, and spaced
about 1 cm. therefrom, is a second anchor member 50, which is best
seen in FIG. 5 to comprise two loop sections 52 formed on opposite
sides of the shaft member body 10, each of the loops defining a
central aperture 54. The function of the anchor member 50 is to
assist in anchoring the shaft member in place, as will be more
fully described hereinafter.
The distal end 12 of the unit has a rounded tip of approximately
0.5 cm. length, and the distance from the tip to the distal end of
anchor member 44 is approximately 2.0 cm. to 3.5 cm.
The distance from the proximal end of anchor member 50 to the
proximal end of conduit 18 is, in the preferred embodiment of the
invention, about 30 cm. to about 32 cm.
The diameter of shaft member 10 is preferably in the range from
about 5 mm. to about 7 mm. The anchor members 50 are approximately
3 mm. in their longitudinal dimension.
The abortion facilitating device of the invention is formed of a
medically acceptable, sterilizable, non-toxic, non-irritating
material, of a type which is well-known in the art, such as latex,
rubber, silicone rubber, or Silastic, a silicone elastomer. It may
be desirable, depending upon the particular rigidity of the
material of which the shaft member is constructed, to mold a scrim
of Dacron or similar material into the material of the shaft
member, in a well-known manner, to give it greater rigidity, and
thereby make it more convenient to handle. The abortion facilitator
of this invention is preferably molded of a unitary body of
material, in a manner which is known in the art, although it is
within the purview of this invention to mold elements separately
and bond them together utilizing adhesives, plasticizers or other
well-known techniques or means.
It may also be desirable to incorporate a reinforcing scrim of
Dacron or similar material into the wall 48 of dilating member 46,
in order to insure that the dimensional integrity of the dilating
member is maintained, in substantially cylindrical form, as the
dilating member is expanded against the walls of the cervix, in the
manner described hereinafter.
As shown in FIG. 1, the abortion facilitator device of the
invention is packaged in a closed, hermetically sealed envelope 60,
of a type which is well-known in the art, and which is sterilized
within the envelope, such as by initially evacuating the envelope
with the abortion facilitator device inside, and replacing the
interior of the envelope with a sterilizing medium such as ethylene
oxide, and subsequently evacuating and sealing the envelope. This
would insure the sterility of the unit prior to its use.
In manufacturing the cervical dilator device of this invention, the
respective terminal ends 34 and 36 of conduits 14 and 16 may be
formed, in a manner which is well-known in the art, with a
resealable membrane of rubber, latex, or the like, to permit the
maintenance of the sterility of the interior of conduits 14 and 16
and channels 24 and 26 when the dilating unit is located in situ.
Alternatively, each of the conduits or one or more of the conduits
could be packaged with a Luer lock adapter inserted therein, to
permit connecting of the respective conduits to suitable syringes
or other devices for the introduction of fluids, having mating Luer
lock members, in a manner which is well-known in the art.
The abortion facilitator device of this invention, and the process
of its use of this invention, are utilized in connection with the
performance of an abortion, which is usually performed by
dilatation and curettage, or, in the case of pregnancies of 17
weeks or greater duration, the medicated inducement of spontaneous
abortion (as by the use of hypertonic saline plus oxytocics). One
currently popular way for performing such an abortion is by the use
of a vacuum device. Such a vacuum device, using different-sized
cannulae, each of which has a substantial cross-sectional
dimension, on the order of 10 to 14 mm. of the cannula or suction
tip portion which enters the uterus. A substantial amount of
cervical dilation is necessary, prior to undertaking the actual
abortion procedure, in order to allow the cannula or suction tip of
the vacuum device to be inserted in the uterus. The particular size
of the cervix, and the amount of dilation necessary in order to
allow a properly sized vacuum device to enter the uterus and
evacuate the uterus will depend upon the stage of the pregnancy.
The earlier the pregnancy, the less the amount of dilatation of the
uterus which is necessary prior to performing the abortion.
Also, pregnancies which are at or beyond the 17 week stage,
require, in addition to substantial dilatation, a stimulation of
the lower uterine segment, in order to have an effective abortion.
The stimulation of the lower uterine segment is desirable in order
to cause spontaneous abortion to occur and expel naturally most of
the products of conception; then the remaining products of
conception in the uterus may be removed relatively easily by
abortion curettage or the usual dilatation and curettage procedure.
The commencement of abortion at the 17 week or later stage is
usually commenced by the introduction trans-abdominally of
hypertonic saline to stimulate spontaneous abortion to remove most
of the products of conception, after which a conventional D & C
is performed.
As previously noted, the currently accepted technique for cervical
dilation prior to vacuum mechanism insertion to perform abortion,
is by inserting into the cervix, which has a soft and pulpy
consistency during pregnancy, metal dilators which are used to
dilate and stretch the cervix to the dilated condition. The use of
such metal dilators is undesirable for a number of reasons,
including the likelihood that minor or even major lacerations of
the cervix could occur, causing pain and requiring suturing, and
occasionally the more disastrous possibility of a uterine
perforation can occur. Such uterine perforations can result in
bowel injury or an accidental hysterectomy. Also, traumatizing the
cervix by the use of metal dilators may cause dangerous
hemorrhaging and also may have deleterious effects on later
pregnancies of the patient.
The apparatus and process of the instant invention provide for the
gradual, controlled, uniform dilation of the cervix by the device
of the invention which, because of the construction of the device
and because it is formed of medically acceptable, flexible smooth
materials, permits atraumatic dilatation to be achieved without
damage to the cervix. The atraumatic nature of the process, without
sacrificing safety or comfort of the patient, can avoid, to a
substantial extent, the necessity for heavily anesthetizing the
cervical area, which is otherwise necessary because of the pain and
discomfort attendant upon dilatation of the cervix using metal
dilators.
Moreover, the process and apparatus of this invention, by
introducing a foreign body into the uterus and further disturbing
the pregnancy by the expansion of anchoring device 44, create a
reasonable prospect that spontaneous abortion will occur, leaving
only a minor removal of residual pregnancy to be done by the
medical professional.
It is also desirable, during the dilation of the cervix, on
occasion, to permit drainage of fluid from the uterine cavity, and
it is sometimes desirable to be able to introduce medication into
the uterine cavity, such as Rivanol both of which desiderata are
provided by the apparatus of this invention.
The process of this invention comprises the introduction of a
foreign body into the uterus and gradual and uniform dilation of an
otherwise undilated cervix, prior to the performing of an abortion,
by gradually and radially uniformly mechanically expanding the
cervix, and, after the cervix is fully dilated, allowing the
foreign body to remain in utero for a period of up to about 24
hours. The expandable dilating member is uniformly and gradually
radially expanded during a period of up to about four hours, while
maintaining substantially along its entire length, and therefore
substantially along the entire length of the cervix, a generally
uniform cross-sectional dimension. The precise rate of expansion of
the dilating member will be determined by the physician or medical
professional, and may be varied as indicated by experience with the
patient, until the cervix is dilated to the maximum necessary
extent. It is to be appreciated that the extent of dilation of the
cervix will vary in accordance with the duration of the pregnancy
of the patient being aborted.
In the process of this invention the physician or other medical
professional could either insert the abortion facilitator device on
the evening before the day on which the abortion is to be
performed, or on the day the abortion is to be performed. If done
the previous evening, anchor 44 is promptly fully dilated, such as
within a one or two minute period, and dilator member 46 will be
expanded gradually during a period of up to about four hours and
the device, in fully expanded condition, is allowed to remain in
place overnight. The next morning, if abortion has not occurred
spontaneously, the abortion facilitator may be removed and the
abortion completed. If the abortion facilitator device is inserted
on the day of the abortion, it would be inserted, the anchor 44
would be inflated quickly, and the dilating member 46 would be
expanded gradually during a period of up to about 4 hours.
Thereafter, the abortion facilitator may be permitted to remain in
place for several hours before removal to attempt to initiate a
spontaneous abortion, or it may be removed promptly after it is
fully expanded to perform the abortion. If spontaneous abortion
does occur, and this is a very desirable result, then all which
remains to be done is to use vacuum curettage or evacuation and
curettage to remove from the uterus the remaining products of
conception. It is notable that the insertion of the abortion
facilitating member of the invention may be done at a doctor's
office or clinic and the patient could be sent home overnight with
the abortion facilitating member in place in the fully expanded
condition. The patient would return the next morning for removal of
the abortion facilitating member and completion of the
abortion.
Generally, if the abortion is being performed during about the
sixth week of the pregnancy, the amount of cervical dilation
desired is at least about 10 mm. Therefore, for performing
abortions during the first 6 weeks of pregnancy, the length of the
dilating member 46 would be about 5 cm., and its inflated diameter
would be about somewhat greater than 10 mm. and would preferably be
expandable up to about 15 mm. In a unit intended to be used during
the first 6 weeks of pregnancy, the anchoring member 44 would have
a diameter of about 1.5 cm. in the inflated condition and a length
of about 1 cm.
For women having pregnancies of more than about 6 weeks and up to
about 12 weeks duration, at least about 12 mm. of cervical dilation
is desired, and, accordingly, the dilating member of a device
intended to be used with a person in this stage of pregnancy would
have an inflated diameter of at least about 12 mm. and would
preferably be expandable up to a diameter of about 30 mm. and would
also have a length of approximately 6 cm. In such a unit, the
anchoring member 44 would have an inflated diameter of at least
about 12 mm. and preferably up to about 30 mm. and a length of
about 1 cm.
The dilating member for use with women having pregnancy of a
duration of more than about 12 weeks, would have an expanded
diameter of at least about 14 mm. and preferably up to about 40 mm.
for the dilating member 46, which would also have a length of 6
cm., to achieve dilatation of at least about 14 mm., and the
anchoring member 44 would correspondingly haVe an expanded diameter
of at least about 14 mm. and preferably up to about 40 mm. and
would have a length of 1 cm.
It is to be noted that the expandable member 46 is preferably
designed to be expanded substantially in excess of the minimum
degree of cervical dilatation necessary to perform the abortion.
This design preference is recommended in order to permit maximum
flexibility in the use of the inventive device and to provide
maximum dilatation for ease of abortion.
Accordingly, 3 different sizes of abortion facilitator units would
reasonably be able to accommodate the different degrees of cervical
dilatation desired for insertion of the currently used sizes of
cannulae or suction tips for suction curettage during different
stages of pregnancies. Of course, in the event that more limited
and controlled amounts of expansion are desired, units can be made
having smaller increments of difference of dimensions. Also, since
the dimensions and conditions of a patient may vary, it may be
necessary or desirable to use a smaller or larger unit than usual
with a particular person, and it is to be noted that the dimensions
of the abortion facilitator unit to be used as described herein and
the extent of dilatation to be achieved with patients with
different stages of pregnancies are general recommendations
only.
Once the desired degree of dilatation is achieved, the dilating
member 46 and anchor member 44 are deflated to their original
sizes, and the abortion facilitator member is removed from the
patient to permit the remainder of the abortion procedure to take
place.
More specifically, in the performance of the process of the
invention, the examining physician or other medical professional
would examine the patient to determine the condition of the patient
and the size of the pregnant uterus, so that the appropriate size
of abortion facilitating device would be selected. The physician or
other medical professional would also determine whether the uterus
is anteverted or retroverted. When this is determined, a
non-traumatizing tenaculum could be attached temporarily to the
anterior lip of the cervix in order to steady it, and an antiseptic
applied to the cervix, this being done while visualizing the cervix
through a speculum.
Using sterile gloves and maintaining a sterile set-up, the abortion
facilitating device 8 of this invention of appropriate size, is
then removed from its sterile envelope 60, and a small amount of KY
jelly is applied to the distal end 12 thereof. The abortion
facilitating device 8 would then be slid into the uterus, it being
appreciated that, at this point in the process, both anchor member
44 and dilating member 46 are in the deflated condition. Anchor
member 50 determines the approximate maximum degree to which the
distal portion of the dilating member of the abortion facilitator
device of the invention can be inserted in the cervix, and, in the
usual position, the anchor member 50 would be spaced approximately
1 cm. from the anterior end of the cervix. At this point, the
deflated dilating member 46 is seated within the cervical canal or
cervical os and the proximal end 20 of shaft member 10 and conduits
14, 16 and 18 extend substantially without the patient's vagina,
for easy connection to suitable fluid introduction devices. At this
point also, the distal end of the abortion facilitator unit,
including anchor member 44, extend into the uterus in the manner
shown in FIG. 6 (except that neither member 44 or 46 is yet
inflated) and constitute a foreign and disruptive body in the
uterus.
It may be desired to fasten initially the abortion facilitator unit
8 in place by applying a few sutures to the cervix and around the
wings 50. The apertures 54 in wings 50 also allow the physician to
pass a tenaculum through the aperture in each wing and thus grasp
the cervix on either side for possible carbocaine injections of the
parametria.
Anchor member 44 and dilating member 46 are next inflated to their
appropriate maximum sizes which will be in the range of 1.5 cm. to
4 cm., depending upon the particular size of abortion facilitating
unit being used. This expansion may be accomplished by injecting a
suitable amount of sterile water into the respective conduits 14
and 16. This water can be introduced through a syringe having a
suitable Luer lock connection member, for example, if a Luer lock
connection is packaged as part of the abortion facilitation member
of the invention. Liquid is introduced via conduit 14 to promptly
and fully inflate member 44, and conduit 16 is then connected to a
Harvard infusion pump (not shown) with a Luer lock or other
suitable connection, for the purpose of introducing at a gradual
and controlled rate, a controlled quantity of liquid to inflate
member 46. If resealable closure members at the ends of conduit 14
and 16 are utilized, a syringe needle can be used for introducing
the proper amount of liquid.
For an anchor member having an inflated diameter of 1.5 cm.
approximately 3 cc. of sterile water would be required for proper
inflation. In a dilating member in which the expanded diameter of
anchor 44 is 3 cm., approximately 5 cc. of water would be required,
and in the anchoring member which will be 4 cm. in diameter in the
inflated condition approximately 10 cc. of water would be required
for proper inflation. The anchoring members are usually inflated
rapidly, within about a minute or two. However, it is to be
understood that the exact timing and rate of introduction of fluid
is quite variable and will depend on the physician's or other
medical professional's judgement of the optimum conditions for the
particular patient.
The amount of liquid which is required to inflate the dilating
member 46 will depend upon the size of the dilating member. For a
dilating member 46 which will have a diameter of 1.5 cm. and a
length of 5 cm. in the inflated condition, approximately 12 cc. of
sterile water or other fluid would be required for proper
inflation. A dilating member 46 which, in the inflated condition,
would have a diameter of about 3 cm. and a length of about 6 cm.
would be inflated with approximately 30 cc. of sterile water, and a
dilating member 46 which, in the inflated condition, would have a
diameter of about 4 cm. and a length of about 6 cm. would be
inflated with approximately 60 cc. of sterile water. In inflating
the dilating member 46, it will initially be desirable to introduce
10 to 20 percent of the filled capacity of the dilating member,
recognizing that introduction of fluid can be dicontinued
temporarily at any time if the patient is experiencing any
substantial pain or discomfort. The remaining fluid may be
introduced at a rate of about 10 percent of the filled capacity of
the dilating member 46 during each half hour. However, it is to be
understood that the exact timing and rate of introduction of fluid
is quite variable and will depend upon the physician's or other
medical professional's judgment of the optimum conditions for the
particular patient.
It is to be noted that the anchoring member 44 will preferably be
inflated relatively rapidly prior to commencement of inflation of
dilating member 46.
The time period during which the dilatation takes place, will, of
course, depend upon the amount of dilation which is to be achieved,
and dilatation will most desirably be achieved gradually during a
period of about 4 hours. The dilatation of the cervix can be
accomplished in substantially less than 4 hours, but if done too
quickly it may be painful to the patient thereby avoiding an
important benefit of the practice of this invention. The precise
timing and the rate will best be determined by the physician
handling the patient, but it is quite desirable to do the dilating
at a relatively uniform rate in order to achieve optimum results in
the minimum time period with minimum patient discomfort.
As soon as the abortion facilitating device 8 of this invention is
located in place within the uterus, any blood within the uterine
cavity is allowed to drain out through the apertures 30 and channel
28 and exit through conduit 18. A suitable syringe may be connected
to conduit 18, for the removal of any blood or other fluid.
Similarly, if it is desirable to introduce medication into the
uterine cavity, such as a Rivanol solution, for example, this can
be introduced through a syringe suitably connected at the proximal
end 38 of conduit 18.
Once the dilation has been completed, the liquid in anchor member
44 would first be removed, in the same fashion as was originally
introduced, by the use of a suitable syringe, and any sutures
fastening anchor member 50 to the cervix would also be cut and
removed.
At this time, the liquid utilized to inflate dilating member 46
would be removed by using a syringe or pump connected to the
proximal end 36 of conduit 16, as a result of which the dilating
member 46 would deflate to its condition illustrated in FIG. 1. At
this point in time, the abortion facilitator unit 8 would be ready
for removal, and could easily be removed by the physician, at which
time the cervix will be dilated to the desired degree, and the
abortion can proceed.
It is to be noted that, although sterile water is preferred as the
means for inflating anchor member 44 and dilating member 46, other
sterile, medically acceptable fluids can be used, which could
either be gases under pressure or liquids.
It will therefore be recognized that the apparatus and process of
this invention provide a convenient, safe and effective method for
initiating and facilitating abortions and for safely achieving
cervical dilation and permitting uterine drainage and
administration of medication prior to the performing of
abortions.
It will be appreciated that, although particular materials, shapes
and dimensions of the apparatus and of the process of this
invention have been described, certain changes in these materials
and shapes and dimensions and process conditions can be made
without departing from the purview of this invention.
* * * * *