Second‐trimester pregnancy termination with oral misoprostol in women who have had one cesarean section

Tarım, Ebru; Kılıçdağ, Esra Bulgan; Bağış, Tayfun; Ilgin, A.; Yanık, Filiz Bilgin

doi:10.1016/j.ijgo.2004.12.047

Cited by 12 publications

(3 citation statements)

References 4 publications

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“…Characteristics of the 17 included studies (including ours) are shown in Table 1 (case series and cohort studies) and Table 2 (case reports). [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Additional information from one study 14 could not be obtained, despite numerous email and phone attempts. The cases of uterine rupture analysed by incision number and type are shown in Table 3 (case series and cohort studies).…”

Section: Resultsmentioning

confidence: 99%

Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review

Berghella

Airoldi

O'Neill

et al. 2009

BJOG

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Background Second trimester pregnancy induction with misoprostol in women with prior caesarean delivery is not well studied.Objective To estimate the risk of uterine rupture using misoprostol as an induction agent for pregnancy termination in the second trimester of pregnancy in women with prior caesarean delivery.Search strategy Cases of women with a history of prior caesarean delivery and subsequent misoprostol induction for pregnancy termination in the second trimester (16-28 weeks) were obtained from two main data sources. First, a retrospective chart analysis was performed at Thomas Jefferson University Hospital and Christiana Hospital between 1998 and 2004. Second, multiple Medline, Scopus and POPLINE literature searches were performed.Selection criteria Case series and cohort studies of women with one or more prior caesarean delivery (of any type), and with a subsequent pregnancy with induction of labour for pregnancy termination at 16-28 weeks using misoprostol as the initial primary agent were included. Case reports were analysed separately.Data collection and analysis Total cases were analysed by type and number of prior caesarean delivery, for the primary outcome of uterine rupture.Main results The incidence of uterine rupture associated with second trimester misoprostol termination was 0.4% (2/461) in women with one prior low transverse, 0% (0/46) in those with two prior low transverse and 50% (1/2) in those with a prior classical caesarean delivery. One of the cases of uterine rupture in a woman with a prior low transverse caesarean required transfusion. None of the total eight cases (including case reports) of uterine rupture was associated with hysterectomy.Conclusions Second trimester misoprostol termination appears safe among women with one prior low transverse caesarean birth, as it is associated with incidences of uterine rupture of 0.4% (95% confidence interval 0.08-1.67%), of hysterectomy of 0% and of transfusion of 0.2%. There are insufficient data on risk with more than one prior caesarean birth or with prior classical caesarean birth.Keywords Induction, misoprostol, prior cesarean, second trimester.Please cite this paper as: Berghella V, Airoldi J, O'Neill A, Einhorn K, Hoffman M. Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review.

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Section: Resultsmentioning

confidence: 99%

Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review

Berghella

Airoldi

O'Neill

et al. 2009

BJOG

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“… Presence of a uterine scar: Although there is no evidence that the presence of a previous cesarean section scar will increase the rate of complications [10–12], rupture of the uterus has been reported [13–15]. Therefore, misoprostol should be used with caution in these women — indeed it may be safer to start with a lower dose of misoprostol. …”

Section: Precautionsmentioning

confidence: 99%

Misoprostol for the termination of pregnancy with a live fetus at 13 to 26 weeks

Blumenthal

Gemzell‐Danielsson

et al. 2007

Intl J Gynecology & Obste

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A combination of mifepristone and misoprostol is the regimen of choice for termination of pregnancy between 13 to 26 weeks. In many countries, mifepristone is still not available, and misoprostol has to be used alone. Many misoprostol-alone regimens have been reported in the literature with apparently good results. Most of the trials were conducted in pregnancies between 13 and 22 weeks. For this gestational period, we recommend the regimen of 400 microg of vaginal misoprostol every 3 h up to 5 doses, as it appears to be effective without excessive side effects or complications. There is inadequate data to recommend a regimen for the gestational period of 23 to 26 weeks but it is advisable to reduce the dose and frequency of administration of misoprostol. Common side effects of misoprostol-induced termination of pregnancy include gastrointestinal side effects, abdominal cramps, bleeding, fever and chills. Complications may include infection or rarely rupture of uterus.

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“…Seven studies used misoprostol alone to induce abortion. 9,[12][13][14][15][16][17] The remaining studies used misoprostol in combination with other medicinal agents to effect cervical dilation. Seven studies described using oxytocin in addition to misoprostol.…”

Section: Resultsmentioning

confidence: 99%

Uterine Rupture in Second-Trimester Misoprostol-Induced Abortion After Cesarean Delivery

Goyal

2009

Obstetrics &Amp; Gynecology

106

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Second‐trimester pregnancy termination with oral misoprostol in women who have had one cesarean section

Cited by 12 publications

References 4 publications

Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review

Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review

Misoprostol for the termination of pregnancy with a live fetus at 13 to 26 weeks

Uterine Rupture in Second-Trimester Misoprostol-Induced Abortion After Cesarean Delivery

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