Induced second trimester abortion by extra-amniotic prostaglandin infusion in patients with a cesarean scar: is it safe?

Abstract

Background: One result of the advancement in prenatal diagnosis is an increase in the need for second trimester pregnancy terminations. Extra-amniotic infusion of prostaglandins is a common technique used for such pregnancy termination. Since prostaglandins cause strong uterine contractions, many practitioners are hesitant to use this technique on women with a uterine scar. In this study we tried to evaluate the effectiveness and safety of the technique for women with a previous uterine scar.

Methods: This retrospective study included all women with a complete medical record who underwent a second trimester pregnancy termination at our institution by extra amniotic prostaglandin E2, during a 6 year period. The study group included all women with a previous uterine scar. The group of women without such a scar served as the control group.

Results: Three hundred and forty women had their pregnancy terminated, but only in 282 cases was the medical information complete (research population). The study group (35 women) characteristics were similar to those of the control group (247 women). We found no difference in the abortion interval, the need to use an additional method, the need for curettage and in bleeding complication between the two groups. There was no case of uterine rupture. The group of women with multiple uterine scars was too small for analysis.

Conclusions: Our results suggest that extra amniotic prostaglandin infusion is an effective and safe technique in women with a uterine scar.

PIP: This retrospective study examines the effectiveness of second trimester-induced abortion using prostaglandin infusion among patients with a previous cesarean scar. Data were gathered from medical records of all women who underwent second trimester pregnancy termination using extra-amniotic prostaglandin E2 (PGE2) infusion at Meir Hospital between January 1992 and November 1997. Women with a history of cesarean section comprised the study group (35) and women without scar served as controls (247). This technique involved the infusion of 10 mg PGE2/500 ml of normal saline to noncesarean women and 5 mg PGE2/500 ml to women who had undergone cesarean section. The study found no significant difference between the two groups in the need for a special procedure such as curettage and/or bleeding complications and uterine rupture. Results demonstrated that the presence of a cesarean scar does not seem to pose a risk in this technique. Extra-amniotic prostaglandin infusion was therefore an effective and safe technique for second trimester pregnancy termination among women with previous uterine scar.