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Pongsatha S, Suntornlimsiri N, Tongsong T. Comparing the outcomes of termination of second trimester pregnancy with a live fetus using intravaginal misoprostol between women with and without previous cesarean section. BMC Pregnancy Childbirth 2024; 24:274. [PMID: 38609883 PMCID: PMC11015687 DOI: 10.1186/s12884-024-06442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE To compare the outcomes of termination of pregnancy with live fetuses in the second trimester (14-28 weeks), using misoprostol 400 mcg intravaginal every 6 h, between women with previous cesarean section (PCS) and no previous cesarean section (no PCS). METHODS A comparative study was conducted on a prospective database of pregnancy termination in the second trimester, Chiang Mai university hospital. Inclusion criteria included: (1) singleton pregnancy; (2) gestational age between 14 and 28 weeks; and (3) pregnancy with a live fetus and medically indicated for termination. The participants were categorized into two groups; PCS and no PCS group. All were terminated using misoprostol 400 mcg intravaginal every 6 h. The main outcomes were induction to fetal delivery interval and success rate, defined as fetal delivery within 48 h. RESULTS A total of 238 women, including 80 PCS and 158 no PCS, were recruited. The success rate of fetal delivery within 48 h between both groups was not significantly different (91.3% vs. 93.0%; p-value 0.622). The induction to fetal delivery interval were not significantly different (1531 vs. 1279 min; p-value > 0.05). Gestational age was an independent factor for the success rate and required dosage of misoprostol. The rates of most adverse effects of misoprostol were similar. One case (1.3%) in the PCS group developed uterine rupture during termination, ending up with safe and successful surgical removal and uterine repair. CONCLUSION Intravaginal misoprostol is highly effective for second trimester termination of pregnancy with PCS and those with no PCS, with similar success rate and induction to fetal delivery interval. Gestational age was an independent factor for the success rate and required dosage of misoprostol. Uterine rupture could occur in 1.3% of PCS, implying that high precaution must be taken for early detection and proper management. SYNOPSIS Intravaginal misoprostol is highly effective for termination of second trimester pregnancy with a live fetus, with a comparable success rate between women with and without previous cesarean section, with a 1.3% risk of uterine rupture among women with previous cesarean section.
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Affiliation(s)
- Saipin Pongsatha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nuchanart Suntornlimsiri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Mifepristone pretreatment followed by misoprostol 200 mcg buccal for the medical management of intrauterine fetal death at 14-28 weeks: A randomized, placebo-controlled, double blind trial. Contraception 2020; 102:7-12. [PMID: 32135126 DOI: 10.1016/j.contraception.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/12/2020] [Accepted: 02/15/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate whether fetal and placental expulsion is more likely within 48 h if women receive mifepristone pre-treatment vs placebo pre-treatment followed by misoprostol 200 mcg buccally for treatment of fetal death at 14 weeks 0 days to 28 weeks and 6 days gestation. STUDY DESIGN We randomized 176 women with a confirmed fetal death between 14 weeks and 0 days to 28 weeks and 6 days to mifepristone 200 mg or placebo; 24 h later all participants received misoprostol 200 mcg buccally every 3 h for up to 16 doses or 48 h. The trial took place in Hanoi, Vietnam and Mexico City in 2015-2018. RESULTS Complete expulsion of the fetus and placenta within 48 h of misoprostol administration occurred in 74 of 90 women (82.2%, 95% confidence interval (CI), 72.7%-89.5%) in the mifepristone-misoprostol group and in 70 of 86 women (81.4%, 95% CI, 71.6%-89.0%) in the placebo-misoprostol group (Relative Risk (RR) 1.01, 95%CI 0.87-1.16, p = 0.887). The median time from the start of the misoprostol induction to fetal expulsion was shorter among women who received mifepristone-misoprostol compared to women assigned to placebo-misoprostol (7 h vs ±5 vs 12 ± 13 h; p < 0.001). Women in the mifepristone-misoprostol group were more likely to expel the fetus within 24 h of the start of misoprostol administration (96% vs 78%; RR 1.22 (1.09-1.39) p = 0.009). CONCLUSION(S) Mifepristone-misoprostol did not result in a higher rate of complete expulsion of the fetus and the placenta within 48 h of the start of misoprostol administration without any additional surgical intervention or medication (e.g. additional misoprostol doses or oxytocin) than placebo-misoprostol. However, treatment with mifepristone-misoprostol did result in a shorter time to expulsion than placebo misoprostol. IMPLICATIONS Pretreatment with mifepristone followed by misoprostol bucally resulted in a shorter treatment time for medical management of fetal death than treatment with misoprostol alone. Pre-treatment with mifepristone may be more acceptable to women and providers by both reducing the length of hospital stay and the amount of misoprostol required.
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Fyfe R, Murray H. Comparison of induction of labour regimes for termination of pregnancy, with and without mifepristone, from 20 to 41 weeks gestation. Aust N Z J Obstet Gynaecol 2017; 57:604-608. [DOI: 10.1111/ajo.12648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/25/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Rina Fyfe
- John Hunter Hospital; Newcastle New South Wales Australia
| | - Henry Murray
- John Hunter Hospital; Newcastle New South Wales Australia
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Andrikopoulou M, Lavery JA, Ananth CV, Vintzileos AM. Cervical ripening agents in the second trimester of pregnancy in women with a scarred uterus: a systematic review and metaanalysis of observational studies. Am J Obstet Gynecol 2016; 215:177-94. [PMID: 27018469 DOI: 10.1016/j.ajog.2016.03.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 03/16/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The aim of this systematic review and metaanalysis was to determine the efficacy and safety of cervical ripening agents in the second trimester of pregnancy in patients with previous cesarean delivery. STUDY DESIGN Data sources were PubMed, EMBASE, CINAHL, LILACS, Google Scholar, and clinicaltrials.gov (1983 through 2015). Eligibility criteria were cohort or cross-sectional studies that reported on efficacy and safety of cervical ripening agents in patients with previous cesarean delivery. Efficacy was determined based on the proportion of patients achieving vaginal delivery and vaginal delivery within 24 hours following administration of a cervical ripening agent. Safety was assessed by the risk of uterine rupture and complications such as retained placental products, blood transfusion requirement, and endometritis, when available, as secondary outcomes. Of the 176 studies identified, 38 met the inclusion criteria. Of these, 17 studies were descriptive and 21 studies compared the efficacy and safety of cervical ripening agents between patients with previous cesarean and those with no previous cesarean. From included studies, we abstracted data on cervical ripening agents and estimated the pooled risk differences and risk ratios with 95% confidence intervals. To account for between-study heterogeneity, we estimated risk ratios based on underlying random effects analyses. Publication bias was assessed via funnel plots and across-study heterogeneity was assessed based on the I(2) measure. RESULTS The most commonly used agent was PGE1. In descriptive studies, PGE1 was associated with a vaginal delivery rate of 96.8%, of which 76.3% occurred within 24 hours, uterine rupture in 0.8%, retained placenta in 10.8%, and endometritis in 3.9% in patients with ≥1 cesarean. In comparative studies, the use of PGE1, PGE2, and mechanical methods (laminaria and dilation and curettage) were equally efficacious in achieving vaginal delivery between patients with and without prior cesarean (risk ratio, 0.99, and 95% confidence interval, 0.98-1.00; risk ratio, 1.00, and 95% confidence interval, 0.98-1.02; and risk ratio, 1.00, and 95% confidence interval, 0.98-1.01; respectively). In patients with history of ≥1 cesarean the use of PGE1 was associated with higher risk of uterine rupture (risk ratio, 6.57; 95% confidence interval, 2.21-19.52) and retained placenta (risk ratio, 1.21; 95% confidence interval, 1.03-1.43) compared to women without a prior cesarean. However, the risk of uterine rupture among women with history of only 1 cesarean (0.47%) was not statistically significant (risk ratio, 2.36; 95% confidence interval, 0.39-14.32), whereas among those with history of ≥2 cesareans (2.5%) was increased as compared to those with no previous cesarean (0.08%) (risk ratio, 17.55; 95% confidence interval, 3.00-102.8). Funnel plots did not demonstrate any clear evidence of publication bias. Across-study heterogeneity ranged from 0-81%. CONCLUSION This systematic review and metaanalysis provides evidence that PGE1, PGE2, and mechanical methods are efficacious for achieving vaginal delivery in women with previous cesarean delivery. The use of prostaglandin PGE1 in the second trimester was not associated with significantly increased risk for uterine rupture among women with only 1 cesarean; however, this risk was substantially increased among women with ≥2 cesareans although the absolute risk appeared to be relatively small.
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Affiliation(s)
- Maria Andrikopoulou
- Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, NY.
| | - Jessica A Lavery
- Biostatistics Coordinating Center, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Cande V Ananth
- Biostatistics Coordinating Center, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY
| | - Anthony M Vintzileos
- Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, NY
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Clark W, Shannon C, Winikoff B. Misoprostol for uterine evacuation in induced abortion and pregnancy failure. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.1.67] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mifepristone–Misoprostol Dosing Interval and Effect on Induction Abortion Times. Obstet Gynecol 2013; 121:1335-1347. [DOI: 10.1097/aog.0b013e3182932f37] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Guerci P, Vial F, Raft J, Nelis UM, Mory S, Morel O, Bouaziz H. [Medical termination of pregnancy in a patient with severe cystic fibrosis. Possible effect of the antiglucocorticoid action of mifepristone on the respiratory disease]. ACTA ACUST UNITED AC 2013; 32:115-7. [PMID: 23286887 DOI: 10.1016/j.annfar.2012.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 11/07/2012] [Indexed: 11/30/2022]
Abstract
Better management of patients with cystic fibrosis has resulted in an increased rate of pregnancy, especially in mild forms. In case of severe respiratory impairment, physiological changes occurring during pregnancy can be life threatening. Medical termination of pregnancy may be necessary. We report a case of severe cystic fibrosis requiring a termination of pregnancy due to significant maternal risk at 17 weeks of gestation. Mifepristone used for induction of labor has a well-known antiglucocorticoid action. We discuss here its potential effect on the onset of an acute pulmonary failure in this patient with long-term corticosteroid therapy.
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Affiliation(s)
- P Guerci
- Maternité régionale de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France
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Domröse CM, Geipel A, Berg C, Lorenzen H, Gembruch U, Willruth A. Second- and third-trimester termination of pregnancy in women with uterine scar — a retrospective analysis of 111 gemeprost-induced terminations of pregnancy after previous cesarean delivery. Contraception 2012; 85:589-94. [PMID: 22079607 DOI: 10.1016/j.contraception.2011.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/03/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
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Zangeneh M, Malek-Khosravi S, Veisi F, Rezavand N, Rezaee M, Rajatee M. Multiple-dose vaginal misoprostol and single-dose misoprostol plus oxytocin for termination of second-trimester pregnancy. Int J Gynaecol Obstet 2012; 117:78-80. [PMID: 22261129 DOI: 10.1016/j.ijgo.2011.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 11/01/2011] [Accepted: 12/22/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare 2 different methods-multiple doses of misoprostol and a combination of misoprostol and oxytocin-for termination of pregnancy in the second trimester. METHODS Between 2006 and 2008, 120 women undergoing termination of second-trimester pregnancy in 2 hospitals in Kermanshah, Iran, were enrolled in a randomized trial comparing 2 treatments. In each treatment group, an initial vaginal dose of 600 μg of misoprostol was placed in the posterior fornix. After 6 hours, an intravenous infusion of concentrated oxytocin was given to women in group A, and 400 μg of vaginal misoprostol was given every 6 hours to women group B, up to a maximum of 4 doses. The outcomes were compared via χ(2) and independent t tests. RESULTS Within 30 hours, 96.7% of women in group A and 96.7% of women in group B delivered successfully. The average duration between induction and delivery time was 12.3±6.0 hours in group A and 12.1±6.0 hours in group B (P>0.05). CONCLUSION The use of misoprostol with oxytocin, and multiple doses of misoprostol gave similar results for termination of pregnancy in the second trimester.
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Affiliation(s)
- Maryam Zangeneh
- High Risk Pregnancy Research Center, Department of Obstetrics and Gynecology, Imam Reza Hospital, Kermanshah University of Medical Science, Kermanshah, Iran.
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Gitz L, Morel O, Thiebaugeorges O, Sibiude J, Desfeux P, Barranger E. Interruptions médicales de grossesse et morts fœtales in utero après 14 semaines d’aménorrhée : quel protocole de déclenchement en 2010 ? Revue de la littérature. ACTA ACUST UNITED AC 2011; 40:1-9. [DOI: 10.1016/j.jgyn.2010.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 11/07/2010] [Accepted: 11/17/2010] [Indexed: 11/26/2022]
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Obata-Yasuoka M, Hamada H, Watanabe H, Shimura R, Toyoda M, Yagi H, Takeshima K, Abe K, Nakamura Y, Ogura T, Fujiki Y, Yoshikawa H. Midtrimester termination of pregnancy using gemeprost in combination with laminaria in women who have previously undergone cesarean section. J Obstet Gynaecol Res 2009; 35:901-5. [PMID: 20149039 DOI: 10.1111/j.1447-0756.2009.01044.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM We aimed to assess the efficacy and safety of midtrimester termination of pregnancy using gemeprost in combination with laminaria in women who had previously undergone cesarean section and in women who had not. METHODS Between January 1999 and December 2006, we carried out a retrospective study of termination of pregnancy at 12-21 weeks of gestation at the University of Tsukuba Hospital. Termination of pregnancy was carried out by three-step uterine cervical dilation using laminaria followed by vaginal administration of 1 mg gemeprost every 3 h for up to four doses over 24 h. RESULTS A total of 173 women underwent midtrimester termination of pregnancy. The women were categorized into two groups: those who had previously undergone cesarean section (n = 26) (previous cesarean section group) and those who had not (n = 147) (control group). Seven women had undergone cesarean section at least twice. The gemeprost dose administered was 2.8 +/- 1.4 mg for the previous cesarean section group and 2.4 +/- 1.6 mg for the control group (difference in doses not significant). Although abnormal vaginal bleeding (>500 mL) was more likely to occur in the previous cesarean section group than in the control group (odds ratio, 2.61; 95% confidence interval, 0.63-10.82), none of the woman required blood transfusion. Uterine rupture and failed abortion were not observed. CONCLUSION The efficacy and safety of our laminaria-gemeprost protocol for termination of pregnancy during the midtrimester are similar for women who have previously undergone cesarean section and those who have not.
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Affiliation(s)
- Mana Obata-Yasuoka
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
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Gómez Ponce de León R, Wing D, Fiala C. Misoprostol for intrauterine fetal death. Int J Gynaecol Obstet 2007; 99 Suppl 2:S190-3. [DOI: 10.1016/j.ijgo.2007.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Intravaginal gemeprost and second-trimester pregnancy termination in the scarred uterus. Int J Gynaecol Obstet 2007; 97:35-9. [DOI: 10.1016/j.ijgo.2006.12.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 12/19/2006] [Accepted: 12/20/2006] [Indexed: 11/18/2022]
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Abstract
The World Health Organization defines unsafe abortion as a procedure for terminating an unintended pregnancy carried out by people lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. The Programme of Action of the International Conference on Population and Development recommends that 'In circumstances where abortion is not against the law, such abortion should be safe'. However, millions of women still risk their lives by undergoing unsafe abortion even if they comply with the law. This is a serious violation of women's human rights, and obstetricians and gynaecologists have a fundamental role in breaking the administrative and procedural barriers to safe abortion. This chapter reviews the magnitude of the problem, its consequences for women's health, the barriers to access to safe abortion, including its legal status, the effect of the law on the rate and the consequences of abortion, the human rights implications and the current evidence on methods to perform safe abortion. This chapter concludes with an analysis of what can be done to change the current situation.
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Affiliation(s)
- Kamini A Rao
- Bangalore Assisted Conception Centre, 6/7, Kumarakrupa Road, Highgrounds, Bangalore-560 001, India
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Kaasen A, Naes T, Haugen G. Which factors influence the number of gemeprost pessaries used in inducing second-trimester abortions? Acta Obstet Gynecol Scand 2005; 84:371-5. [PMID: 15762968 DOI: 10.1111/j.0001-6349.2005.00503.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The course of second-trimester abortions with the intention to use gemeprost as the only abortifacient is described. METHODS The report is based on 278 consecutive second-trimester abortions, excluding missed abortions, during a 12-year period in a tertiary referral center. The women were treated with 1 mg gemeprost pessaries every fourth hour with a maximum of five applications during 24 h. If abortion had not occurred, a new treatment of gemeprost was prescribed after an interval of 12 h. RESULTS The median number of gemeprost pessaries used was 4 (range 1-16) and the mean number (+/-SD) 4.09 (+/-1.90). Abortion occurred within 24 h in 78% of the women and within 48 h in 96%. The efficiency of gemeprost was highly dependent on previous vaginal deliveries (p<0.001), with a mean number of applications of 4.63 (+/-2.04), 3.93 (+/-1.74), and 3.13 (+/-1.26) in those with none, one, and two or more previous vaginal deliveries, respectively. Previous spontaneous abortions were associated with a lower number of applications. Including previous vaginal deliveries and spontaneous abortions in a two-way analysis of variance (anova), only the number of spontaneous abortions was marginally significant (p=0.05). After excluding four patients with three or more spontaneous abortions from the analysis, the number of previous vaginal deliveries was significant (p=0.010) whereas that of spontaneous abortions became nonsignificant. Postprocedure complications were reported in 13% of the women. CONCLUSION The course of the abortions was dependent on previous vaginal deliveries and spontaneous abortions.
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Affiliation(s)
- Anne Kaasen
- Department of Obstetrics and Gynecology, The National Hospital, University of Oslo, Oslo, Norway.
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Scioscia M, Pontrelli G, Vimercati A, Santamato S, Selvaggi L. A short-scheme protocol of gemeprost for midtrimester termination of pregnancy with uterine scar. Contraception 2005; 71:193-6. [PMID: 15722069 DOI: 10.1016/j.contraception.2004.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Revised: 10/25/2004] [Accepted: 10/27/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the safety and effectiveness of a short-scheme protocol of gemeprost for second trimester induction of abortion in women with previous uterine surgery. STUDY DESIGN Retrospective review of women who underwent second trimester medical termination of pregnancy (TOP) at our hospital in a 5-year period. A short regimen of gemeprost was used: over a 24-h period, 1 mg vaginal gemeprost was given every 3 h up to three doses after which, if abortion did not occur, another course at the same dosage schedule was administered up to 4 days. Induction failure was defined as women undelivered by 96 h. A homogeneous population was identified. Statistical analysis was performed with the chi(2) test or Fisher's Exact Test for categorical data and t test for continuous variables. RESULTS Four hundred seventeen women underwent medical midtrimester TOP in the 5-year study period. Two hundred five patients were selected for this review, comparing 63 patients with scarred uterus to 142 women without uterine scars. There were no differences between the two groups in induction-to-abortion interval and number of pessaries given. The overall failure of induction rate was 1.5% and need for blood transfusion was 0.5%. No uterine rupture was reported. CONCLUSION The regimen of gemeprost proposed seems to be as safe and effective in patients with uterine scars as in women with unscarred uteri with a very low incidence of complications.
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Affiliation(s)
- Marco Scioscia
- Department of Obstetrics and Gynaecology, University of Bari, 70125 Bari, Italy.
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Berkane N, Verstraete L, Uzan S, Boog G, Maria B. Use of mifepristone to ripen the cervix and induce labor in term pregnancies. Am J Obstet Gynecol 2005; 192:114-20. [PMID: 15672012 DOI: 10.1016/j.ajog.2004.05.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study was undertaken to determine the efficacy of mifepristone for ripening the cervix and inducing labor in term pregnancies. STUDY DESIGN In a double-blind placebo-controlled dose-finding study, 346 women received 50, 100, 200, 400, or 600 mg of mifepristone or placebo. The main endpoint for efficacy was the number of patients in whom labor occurred between 12 and 45 and 54 hours after treatment or who had a Bishop score 6 or greater. Maternal and fetal tolerability was also studied. RESULTS No significant efficacy was observed whatever the dose of mifepristone. Mifepristone was well tolerated by the mother and fetus. CONCLUSION Mifepristone, at doses up to 600 mg, does not induce labor within 54 hours in patients with unfavourable cervical status.
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Affiliation(s)
- Nadia Berkane
- Department of Gynecology-Obstetrics and Reproductive Medicine, Hôpital Tenon, Paris, France.
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