Document Detail


Termination of pregnancy in patients with previous cesarean section.
MedLine Citation:
PMID:  16472563     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the safety and efficacy of termination of pregnancy using mifepristone and misosprostol at more than 15 weeks' gestation in patients with uterine scar due to previous cesarean section. MATERIALS AND METHODS: This retrospective study was conducted in a tertiary maternity ward between January 2000 and October 2004. A total of 252 women at more than 15 weeks' gestation underwent termination of pregnancy including 50 women with uterine scar due to previous cesarean section (Group 1) and 202 control patients (Group 2) without known uterine scar. Abortion was induced with mifepristone and a prostaglandin analogue. Women between 15 and 34 weeks' gestation received misoprostol intravaginally every 3 h at doses of 200 microg (Group 1) or 400 microg (Group 2). Women at more than 34 weeks' gestation received Prostin E2 vaginal gel. Main end points were hemorrhage, fever, retained placenta, occurrence of complications including uterine rupture and dehiscence, and final outcome. RESULTS: A total of 13 (26%) patients in Group 1 and 79 (39.1%) in Group 2 were at more than 24 weeks' gestation. The abortion failure rate was 2% (1/50) in Group 1 and 0.5% (1/202) in Group 2 (p = .28). The median induction-to-delivery interval was 8.5 h (range, 3.0-114.2 h) for Group 1 and 9.0 h (range, 1.3-124.3 h) in Group 2 (p = .26). One case of uterine rupture and one case of dehiscence were observed, both in women in Group 1. The incidence of hemorrhage was not significantly different between Group 1 and Group 2 (2% vs. 0.9%, respectively, p = .56). The incidence of retained placenta was higher in the Group 1 (70% vs. 52.5%, respectively, p = .025). CONCLUSION: In this retrospective series of women who underwent abortion at 15-35 weeks' gestation using mifepristone and a prostaglandin analogue for labor induction abortion, history of cesarean section was not associated with higher morbidity except risk of uterine rupture. However, dose and interval of misoprostol should be determined. A larger study is needed before drawing definitive conclusions about the safety of these regimens.
Authors:
Chafika Mazouni; Magali Provensal; Géraldine Porcu; Béatrice Guidicelli; Hélène Heckenroth; Marc Gamerre; Florence Bretelle
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Publication Detail:
Type:  Journal Article     Date:  2005-11-02
Journal Detail:
Title:  Contraception     Volume:  73     ISSN:  0010-7824     ISO Abbreviation:  Contraception     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-02-13     Completed Date:  2006-10-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0234361     Medline TA:  Contraception     Country:  United States    
Other Details:
Languages:  eng     Pagination:  244-8     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, Conception Hospital, 13385 Marseille, France. chafika.mazouni@ap-hm.fr
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MeSH Terms
Descriptor/Qualifier:
Abortifacient Agents, Nonsteroidal / administration & dosage*
Abortion, Induced*
Administration, Intravaginal
Administration, Oral
Adult
Cesarean Section*
Dinoprost / administration & dosage,  analogs & derivatives*
Female
France
Humans
Mifepristone / administration & dosage*
Misoprostol / administration & dosage*
Oxytocics / administration & dosage*
Pregnancy
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Retrospective Studies
Ultrasonography, Prenatal
Chemical
Reg. No./Substance:
0/Abortifacient Agents, Nonsteroidal; 0/Oxytocics; 38562-01-5/dinoprost tromethamine; 551-11-1/Dinoprost; 59122-46-2/Misoprostol; 84371-65-3/Mifepristone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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