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Overcoming the Challenging Cervix: Techniques to Access the Uterine Cavity

Christianson, Mindy S. MD1; Barker, Matthew A. MD2; Lindheim, Steven R. MD1

Journal of Lower Genital Tract Disease: January 2008 - Volume 12 - Issue 1 - p 24-31
doi: 10.1097/lgt.0b013e318150676d

Objective. To identify cervical stenosis and review medical, surgical, and radiological modalities to access the uterine cavity.

Materials and Methods. Computerized searches of Medline and PubMed from 1996 to 2005 were conducted using the key words "cervix," "cervical ripening," and "cervical stenosis." References from identified publications were manually searched and cross-referenced to identify additional relevant articles. We review relevant techniques on how to access the uterine cavity when cervical stenosis is encountered.

Results. Many gynecologic procedures require uncomplicated access through the cervix to access the uterine cavity, including hysteroscopy, dilation and curettage, sonohysterogram, hysterosalpingogram, endometrial biopsy, and embryo transfer for in vitro fertilization. These procedures can be quite complicated when a cervix is obstructed. Management techniques described include the medical use of misoprostol and laminaria, intraoperative ultrasound guidance, and operative creation of a new passage. Additionally, techniques for bypassing the obstructed cervix and preventing cervical stenosis have been described.

Conclusions. Cervical stenosis can result in iatrogenic complications. Preoperative identification, cervical ripening agents, osmotic dilators, and the use of ultrasound guidance are useful in overcoming cervical stenosis. It is also key to identify those at risk for cervical stenosis and implement preventative techniques as needed.

Cervical stenosis can be overcome with cervical ripening agents, dilators, ultrasound guidance, and surgical techniques to decrease complications and permit access to the uterine cavity.

1Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, and 2Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH

Reprint requests to: Steven R. Lindheim, MD, Department of Obstetrics and Gynecology, University of Wisconsin Medical School and Public Health, H4/628 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792. E-mail:

©2008The American Society for Colposcopy and Cervical Pathology