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

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Medical second-trimester abortion in women with prior cesarean section (CS) is becoming an increasingly common phenomenon. However, data about the safety of the procedure are limited. This study addresses this issue.

Methods

Retrospective cohort single-center study, done in Hadassah Medical Center in Jerusalem, a tertiary-care university hospital. This study included 779 women who needed pregnancy termination between 13 and 26 gestational weeks. 128 women had at least one previous CS (study group), whereas 651 had no CS (reference group). Protocols used were: (1) misoprostol tablets, 800 mcg vaginally followed by 400 mcg orally every 3 h up to four oral doses, (2) Oxytocin drip. Nearly one-fourth of the women received mifepristone as a preliminary treatment for cervical ripening. The outcomes assessed included the following complications: retained placenta, bleeding with or without requiring blood transfusion, infection, cervical lacerations, uterine adhesions and uterine ruptures.

Results

Previous CS does not appear to increase the incidence of complications, excluding clinical bleeding without requiring blood transfusions (p value 0.05), which has a minimal clinical significance. Oxytocin protocol had 3.44 OR for complications, compared to misoprostol (p value 0.03, CI; 1.12- 10.52). No significant correlation was found between Misoprostol dosage and complications (Mann–Whitney U test, p value 0.057).

Conclusion

Medical second-trimester abortions for women with prior CS should be considered a safe and effective procedure, with a low complication rate. The most serious complication is uterine rupture, which is uncommon; we recorded one case only. Misoprostol protocol should be preferred.

Clinical trial number and date

IRB 0177-17-HMO, 5/2014.

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Funding

There was no source of financial support or funding for the research.

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Author notes

  1. Raz Bahar and Heli Alexandroni equal contribution first authors.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, PO Box 12000, 91120, Jerusalem, Israel

    Raz Bahar, Gilad Karavani, Ronit Gilad & Abraham Benshushan

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel

    Heli Alexandroni

Authors
  1. Raz Bahar
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  2. Heli Alexandroni
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  3. Gilad Karavani
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  4. Ronit Gilad
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  5. Abraham Benshushan
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Contributions

RB: Protocol and project development, data collection and management, data analysis, manuscript writing. HA: data collection, data analysis, manuscript writing. GK: Data analysis, manuscript editing. RG: Manuscript editing. AB: Protocol and project development, manuscript editing.

Corresponding author

Correspondence to Raz Bahar.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study conforms to the ethical guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Hadassah-Hebrew University Medical Center (0177-17-HMO) at May 2014.

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No informed consent was required for this study.

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Bahar, R., Alexandroni, H., Karavani, G. et al. Safety of medical second trimester abortions for women with prior cesarean sections. Arch Gynecol Obstet 303, 1217–1222 (2021). https://doi.org/10.1007/s00404-020-05904-9

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  • DOI: https://doi.org/10.1007/s00404-020-05904-9

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