title: Overcoming the challenging cervix: techniques to access the uterine cavity.
abstract: OBJECTIVE
  To identify cervical stenosis and review medical, surgical, and radiological modalities to access the uterine cavity.
  
  
  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.
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Mindy S
authors.initials: MS
authors.lastname: Christianson
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Barker
authors.forename: Steven R
authors.initials: SR
authors.lastname: Lindheim
mesh_terms: D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000473:pathology*; D003251:Constriction, Pathologic; D004106:Dilatation / Q000379:methods*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007795:Laminaria; D015735:Mifepristone / Q000008:administration & dosage; D016595:Misoprostol / Q000008:administration & dosage; D010120:Oxytocics / Q000008:administration & dosage*; D014463:Ultrasonography / Q000379:methods; D002577:Uterine Cervical Diseases / Q000175:diagnosis / Q000628:therapy*
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D015735:Mifepristone