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University of Michigan Health System

Women’s, Children’s and Behavioral Health Nursing Services

Women’s Hospital Birth Center Triage 

Same as above, except may insert Dilapan (minimum of 10mm) the morningof surgery for minimum of 4 hours.

3.  Between 17 weeks + 0 days and 20 weeks + 6 days

On day prior to surgery – Insert Dilapan (10mm minimum). After 4 hours,

remove Dilapan and insert Laminaria (minimum 20 mm).Start Doycycline 100 mg by mouth q 12 hours x 5 days.

Cytotec 400 mcg (self-administered) to be dissolved in side of mouth, 2 hours prior to D & E.

I.  Recommendation for preparation of cervix for medical induction by gestational

age:

1.  Between 12 weeks + 0 days and 14 weeks + 0 daysConsider Laminaria /Dilapan as below

2. Between 14 weeks + 1 day and 17 weeks + 0 days

On day prior to induction – Place a minimum of 10mm of Laminaria orDilapan.

-  or-May insert Dilapan (minimum of 10mm) the morning of induction forminimum of 4 hours.

2.  Between 17 weeks + 0 days and 23 weeks + 5 days

On day prior to induction – Insert Dilapan (10mm minimum). After 4 hours,remove Dilapan and insert Laminaria (minimum 20 mm).

IV.  Intervention:

A.  Administer Ibuprofen 600 mg po and/or other pain medication to the woman for

her comfort as ordered by the CNM or MD (review allergies). 

J.  Assist CNM or MD with setup needed for laminaria placement. Collect the

following items:1.  assortment of Laminaria, ranging from 3 – 9mm; Dilapan 3mm x 55mm,

4mm x 55mm and 4mm x 65mm.2.  ring forceps

3.  tenaculum forceps

4.   paracervical kit and 1% lidocaine5.  sterile lubricant

6.  6 - 8 sterile 4X4 sponges

7.   betadine solution8.  speculum

9.  exam light

10.  warm saline11.  other items the MD/CNM may request.

K.  Assist with positioning of woman into lithotomy position.

L.  Provide emotional support to woman and significant other during procedure.

M.  Assist CNM or MD as necessary during the procedure. N.  Maintain an accurate count of both the number of Laminaria/Dilapan and the

number of 4X4 sponges placed and record on the worksheet.

O.  If necessary, facilitate a pre-operative workup with both the OB Resident and OBAnesthesia if surgery is to follow the laminaria placement.

P.  Additional medications that may be ordered by CNM/MD after review of patient

allergies:

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University of Michigan Health System

Women’s, Children’s and Behavioral Health Nursing Services

Women’s Hospital Birth Center Triage 

1.  Doxycycline 100 mg by mouth q 12 hours x 5 days. (Prophylactic antibioticsfor women planning D & E. Start with Laminaria/ Dilapan placement, may

take morning of surgery with sip of water).

2.  Cytotec 200 mcg x 2 tablets (total of 400 mcg), woman to dissolve in side of

mouth 2 hours prior to scheduled D & E procedure.

V.  Health Education:

A.  Have patient call Triage if she develops a fever > 100.4.

B.  Instruct patient that she is likely to have cramping and bleeding following the

laminaria placement. Encourage patient to take Ibuprofen 600mg every 6 hours

for cramping pain as needed (review allergies).C.  Have patient call Triage, if she begins to experience active bleeding (soaking > 1

 pad an hour) or if she experiences constant abdominal cramping that lasts longer

than 3 minutes or signs of ruptured membranes.D.  Instruct patient to save and bring with her on her return visit any products of

conception, laminaria and/or gauze that have been expelled at home.E.  Give written information to patient regarding time of scheduled surgery, time

 patient needs to arrive on unit, NPO after midnight (if having D&C or D&E).

Also give patient the Triage number to call with any questions/concerns before

her return visit.

VI.  References:

AWHONN Perinatal Nursing _ Lippincott; Simpson, K.R. and Creehan, P.A.. Edition 2,

2001

Gabbe, et al. Obstetrics: Normal and Problem Pregnancies

VII.  Author(s)Van de Ven, Cosmas, MD

Harris, Lisa, MDMurtland, Terri , CNM

Iamarino, Dannielle RN, BSN

VIII.  Exhibits:

Patient Educational Handout - Laminaria PlacementPain Control for First Trimester Abortion – Gabbe, et al.

Laminaria/Dilapan Worksheet

IX. Signatures:

 __________________________________ ________________________________Margay Britton, MS, RN Cosmas Van De Ven, MD

Director, Patient Care Services Director, MFM Division

 __________________________________

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University of Michigan Health System

Women’s, Children’s and Behavioral Health Nursing Services

Women’s Hospital Birth Center Triage 

Terri L. Murtland, RN, MSN, CNMTriage Coordinator