Cervical ripening agents in the second trimester of pregnancy in women with a scarred uterus: a systematic review and metaanalysis of observational studies

Andrikopoulou, Maria; Ananth, Cande V.; Vintzileos, Anthony M.

doi:10.1016/j.ajog.2016.03.037

Cited by 27 publications

(14 citation statements)

References 70 publications

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“…While uterine rupture rates were similar in the cases that were applied prostaglandin E1 and had one cesarean section during their second trimester terminations, there was a slight increase in the uterine rupture risk of those who had two or more cesarean section previously. [25] In our study, the uterine rupture rate was 0.26% and we did not find any difference in scarred uterines in terms of rupture.…”

Section: Discussioncontrasting

confidence: 43%

The analysis of the termination of pregnancies at and after ten weeks of gestation – a monocenter study

Baran¹,

Alemdaroğlu²,

Durdağ³

et al. 2019

Perinatal J

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On hafta ve üzeri gebelik terminasyonlar›n›n analizi-Tek merkezli çal›flma Amaç: Klini¤imizde yap›lm›fl olan 10 hafta ve üzeri gebelik termi-nasyonlar›n›n endikasyonlar›n› ve obstetrik özelliklerini inceleyerek, bu olgular› daha iyi yönetebilmeyi ve do¤ru yaklafl›mlar› gelifltirebilmeyi amaçlad›k. Yöntem: Ocak 2012-Ocak 2019 aras›nda klini¤imizde gerçekleflmifl 379 terminasyon olgusunun maternal verileri, obstetrik özellikleri ve endikasyonlar› de¤erlendirildi. Endikasyonlar; maternal nedenler, amniyotik s›v› anomalileri, izole yap›sal, çoklu konjenital ve genetik bozukluklar olarak grupland›r›ld›. Gruplar özelliklerine göre s›n›fland›r›ld› ve kendi aralar›nda karfl›laflt›r›ld›. Bulgular: Ortalama yafl 30.2±6, ortalama gebelik haftas› 17.4±3.5, ortalama terminasyon süresi 16.4±14.5 saatti. En s›k amniyotik s›-v› anomalileri nedeniyle terminasyon yap›ld›¤› izlendi (n=126, %33.2). Fetal nedenler içerisinde en s›k izole yap›sal anomaliler (n=114, %30.1) tespit edildi. Santral sinir sistemi anomalileri en çok görülen izole yap›sal anomaliler idi (n=60, %15.8). Terminas-yonlar›n 25/379'u (%6.6) maternal nedenli idi. Genetik bozukluklar için invaziv tetkik istenme oran› %49.6 (n=197), yap›lma oran› %31.7 (n=120) idi. En s›k trizomi 21 (n=39, %55.7) olmak üzere kromozomal anomali 69 (%18.2) olguda tespit edildi. Kromozomal anomalilerin daha ileri maternal yafl ve daha erken gebelik haf-talar›nda tespit edildi¤i izlendi. ‹zole yap›sal ve çoklu konjenital anomalilerin ise daha genç yaflta ve daha ileri gebelik haftalar›nda saptand›¤› görüldü (özellikle kardiyak ve ürogenital anomaliler) (maternal yafl, p=0.002; gebelik haftas›, p<0.001). Sonuç: Terminasyon olgular›n›n yönetiminde fetal ve maternal nedenlerin ve terminasyon komplikasyonlar›n›n analizi, takip eden gebeliklerin tan› ve terminasyon süreçlerinin yönetiminde örnek olacakt›r. Gebelik terminasyonlar›n›n etik, psikolojik, ekonomik ve yasal boyutlar›n›n dikkate al›nmas›, aile ile hekim iflbirli¤i içerisinde bu konuda standart yaklafl›mlar›n oluflturulmas›nda etkili olaca¤› görüflündeyiz.

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Section: Discussioncontrasting

confidence: 43%

The analysis of the termination of pregnancies at and after ten weeks of gestation – a monocenter study

Baran¹,

Alemdaroğlu²,

Durdağ³

et al. 2019

Perinatal J

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“…A more recent systematic review and meta-analysis assessed the efficacy and safety of cervical ripening agents in the second trimester of pregnancy in patients with a previous cesarean delivery 12. The review concluded that PGE1 use was efficacious and was not associated with a significantly increased risk for uterine rupture among women with only one cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review

AlSaad¹,

Al-Obaidly

Abdulrouf³

et al. 2017

TCRM

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Background Misoprostol is an effective medical method for the management of pregnancy loss. However, data on its efficacy and safety in women with previous cesarean deliveries are limited. Case presentation We report a 36-year-old patient, gravida 11 para 6, with a diagnosis of missed miscarriage at 15 weeks of gestation. The patient had a significant obstetric history of previous five cesarean deliveries and uterine rupture. Following patient counseling about the medical and surgical options of managing her miscarriage, the patient opted for medical method. Low-dose misoprostol of 100 µg was inserted vaginally and repeated again after 6 hours. The patient had an uneventful complete miscarriage following the second dose of misoprostol. No uterine rupture, no extra vaginal bleeding, and no blood transfusion were observed. Conclusion We conclude that adopting a low-dose misoprostol protocol could be potentially safe and effective in managing second trimester missed miscarriage in women with repeated cesarean deliveries and/or uterine rupture history. Further studies are needed to confirm these results.

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“…Different methods of cervical ripening have been proposed including synthetic prostaglandins and mechanical methods such as dilatation using laminaria tents or Foley catheter (2)(3)(4). Misoprostol is one of the most common drugs used for termination of pregnancy (5). Most studies on labour induction in case of IUFD or TOP focus on the second trimester only, due to different national abortion policies (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

“…Misoprostol is one of the most common drugs used for termination of pregnancy (5). Most studies on labour induction in case of IUFD or TOP focus on the second trimester only, due to different national abortion policies (5)(6)(7)(8). Efficacy and safety profile of misoprostol use in late gestation or in women with previous CD remain a controversial subject.…”

Section: Introductionmentioning

confidence: 99%

“…These conflicting reports lead to suggest that the safety of misoprostol is yet to be clearly established for women with a scarred uterus (12). A recent review provided evidence that the use of prostaglandins in the second trimester is associated with greater efficacy and is safe for women with only 1 previous CD, but at higher risk of uterine rupture for women with 2 or more previous CD (5). Furthermore, FIGO recommendations concluded that there is insufficient evidence available to recommend a regimen of misoprostol for use at more than 26 weeks' gestation in women who have had a previous caesarean or a transmural uterine scar (13).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of induction of labour in case of pregnancy termination or intrauterine fetal death in patients with a scarred uterus: a retrospective cohort study

et al.

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Objective: Assess efficacy and safety of labour induction in women with one or more previous caesarean deliveries during second and third trimester pregnancy termination or intrauterine fetal death. Design: Retrospective single-centre study between 2007 and 2018. Setting: Lille, France Population: 136 women with history of previous caesarean deliveries (CD) (study group) and 272 controls undergoing labour induction for pregnancy termination or intrauterine fetal death. Methods: Before 32 weeks, misoprostol 400 μg was given orally every 3 hours up to a maximum of five doses in 24 hours. Study group received half doses. After 32 weeks, oxytocin infusion, misoprostol (PGE1) or PGE2 (dinoprostone) were used according to the Bishop score. Main outcome measures: Vaginal delivery within the 24 hours after induction without uterine rupture or severe post-partum haemorrhage defined as blood loss > 1 litre (PPH). Results: Vaginal delivery within the 24 hours after induction without uterine rupture or PPH was 83.5% in the study group versus 92.6% in the control group (p=0.005). 5 (3.7%) uterine ruptures occurred in the study group, 1.7% in case of one previous CD and 15.8% in case of 2 or more previous CD. There were more severe PPH in the study group (6.7% versus 2.2% p=0.03), but no difference was found between women with one or more previous CD. Conclusions: Women with 2 or more prior CD should be informed that they are at higher risk of complications such as uterine rupture and severe post-partum haemorrhage.

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Cervical ripening agents in the second trimester of pregnancy in women with a scarred uterus: a systematic review and metaanalysis of observational studies

Cited by 27 publications

References 70 publications

The analysis of the termination of pregnancies at and after ten weeks of gestation – a monocenter study

The analysis of the termination of pregnancies at and after ten weeks of gestation – a monocenter study

Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review

Efficacy and safety of induction of labour in case of pregnancy termination or intrauterine fetal death in patients with a scarred uterus: a retrospective cohort study

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