Safety of medical second trimester abortions for women with prior cesarean sections

Bahar, Raz; Alexandroni, Heli; Karavani, Gilad; Gilad, Ronit; Benshushan, Abraham

doi:10.1007/s00404-020-05904-9

Cited by 6 publications

(2 citation statements)

References 11 publications

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“…18 Mifepristone was used in only a quarter of cases and a variety of regimens, making comparisons with our data challenging; however, they reported a uterine rupture rate of 0.78% and an increased complication rate when oxytocin was used (OR 3.44; CI 1.12-10.52, P = 0.03). 18 Recently, Latta et al 19 reported a study admixed with abortion and fetal demise cases, of 109 women with prior CS, 32 who had >1 CS. The uterine rupture rate was 6.25% with >1 prior CS, although only 26.5% of women received mifepristone priming.…”

Section: Discussionmentioning

confidence: 59%

“…reported outcomes of second trimester medical abortion in 779 women, of whom 128 had at least one prior CS 18 . Mifepristone was used in only a quarter of cases and a variety of regimens, making comparisons with our data challenging; however, they reported a uterine rupture rate of 0.78% and an increased complication rate when oxytocin was used (OR 3.44; CI 1.12–10.52, P = 0.03) 18 . Recently, Latta et al 19 .…”

Section: Discussionmentioning

confidence: 99%

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Mifepristone priming and subsequent misoprostol for second trimester medical abortion in women with previous caesarean delivery

Dickinson

Doherty

2023

Aust NZ J Obst Gynaeco

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Aims To assess clinical outcomes and complications in women with ≥1 prior caesarean delivery (CS) during mid‐pregnancy medical abortion with misoprostol following mifepristone priming. Materials and Methods Retrospective analysis of abortions at 13–28 weeks gestation using sequential mifepristone and misoprostol at a single centre from 1/2008–12/2018. Procedural outcomes were compared between cases with no prior CS, one prior and ≥2 prior CS. Results There were 1399 consecutive women who underwent a medical abortion, with 304 (21.7%) having ≥1 prior lower segment CS (241 one, 49 two, 12 three, one four) and one a prior classical CS. Median gestation was 19 weeks (interquartile range (IQR) 17–21) among nulliparas, multiparas with no prior CS and multiparas with prior CS, P = 0.505. Compared with nulliparas (median procedural duration 10.8 h, IQR 7.5–16.5; adjusted hazards ratio (aHR) = 1.20 95%CI 1.04–1.40, P = 0.015), multiparas with prior CS had a shorter procedural duration (9.5 h, IQR 6.5–13.5) while multiparas with no CS had the shortest duration (7.0 h, IQR 5.0–9.8; aHR = 2.28 95%CI 2.01–2.58, P < 0.001). Complications were more frequent with prior CS: estimated blood loss (medians: 100 cc no CS vs 150 cc ≥1 CS, P = 0.002), blood loss >1000 cc (3.6% no CS vs 7.2% ≥1 CS; odds ratio (OR) = 2.11 95%CI 1.23–3.62, P = 0.007) and placental retention (17.3% no CS vs 25.3% ≥1 CS; adjusted OR = 1.44 95%CI 1.05–1.99, P = 0.024). Uterine rupture occurred in 4/304 women with ≥1 prior CS (1.3%). Conclusions Mifepristone‐misoprostol abortion in women with prior CS is generally safe but associated with an increased risk of procedural complications. Lowering of the misoprostol dosage with prior CS may reduce uterine rupture, although this hypothesis requires ongoing research.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Mifepristone priming and subsequent misoprostol for second trimester medical abortion in women with previous caesarean delivery

Dickinson

Doherty

2023

Aust NZ J Obst Gynaeco

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The safety of misoprostol alone use for second-trimester termination of pregnancy in women with previous caesarean deliveries

Erturk

Karapinar

Taşgöz

et al. 2022

The European Journal of Contraception & Reproductive Health

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Cohort Study Summary of the Effects of Carboprost Tromethamine Combined with Oxytocin on Infant Outcome, Postpartum Hemorrhage and Uterine Involution of Parturients Undergoing Cesarean Section

Gong¹,

Wu²

2022

Computational and Mathematical Methods in Medicine

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Background. Carboprost tromethamine injection has a high safety factor in clinical application and has a good effect on uterine smooth muscle and vasoconstriction. Carboprost aminobutyriol combined with oxytocin may be beneficial to infant outcome and uterine involution after cesarean section. Objective. To investigate the effects of carboprost tromethamine combined with oxytocin on infant outcome, postpartum hemorrhage, and uterine involution in parturients undergoing cesarean section. Methods. A total of 120 parturients undergone cesarean section in our hospital from February 2019 to April 2021 were selected as the object of study. The parturients were randomly divided into control group ( n = 60 ) and research group ( n = 60 ). The control group was treated with oxytocin, and the research group was treated with carboprost aminobutyriol combined with oxytocin. The amount of maternal bleeding, uterine floor decline index, the end of lochia, poor rate of uterine involution, infant outcome, and the incidence of adverse drug reactions were compared between the two groups. Results. The amount of bleeding in the research group was significantly lower than that in the control group ( P < 0.05 ). The position of the last uterine floor and the index of uterine floor downward movement in the research group were significantly higher than those in the control group ( P < 0.05 ). The disappearance time of bloody lochia and serous lochia in the research group was significantly shorter than that in the control group ( P < 0.05 ). The end time of lochia in the research group was higher than that in the control group, and the rate of uterine involution in the research group was lower than that in the control group ( P < 0.05 ). The neonatal weight and Apgar score in the research group were higher than those in the control group, and the hospitalization rate of neonatal ICU in the research group was significantly lower than that in the control group. The incidence of adverse reactions in the research group was significantly lower than that in the control group ( P < 0.05 ). Conclusion. Carboprost aminobutyriol combined with carbestatin can effectively prevent the occurrence of bleeding after cesarean section, improve uterine involution, and improve neonatal birth quality, which is worth popularizing.

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Safety of medical second trimester abortions for women with prior cesarean sections

Cited by 6 publications

References 11 publications

Mifepristone priming and subsequent misoprostol for second trimester medical abortion in women with previous caesarean delivery

Mifepristone priming and subsequent misoprostol for second trimester medical abortion in women with previous caesarean delivery

The safety of misoprostol alone use for second-trimester termination of pregnancy in women with previous caesarean deliveries

Cohort Study Summary of the Effects of Carboprost Tromethamine Combined with Oxytocin on Infant Outcome, Postpartum Hemorrhage and Uterine Involution of Parturients Undergoing Cesarean Section

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