Labour induction for termination of pregnancy with severe fetal anomalies after 24 weeks’ gestation: a case series and systematic review of the literature

Abstract

Purpose

Under some circumstances, individuals choose to undergo pregnancy termination for foetal anomalies in the second half of pregnancy. This report provides objective information on the clinical management of such cases and a systematic review of the literature on labour induction outcomes for third-trimester abortion using mifepristone-misoprostol.

Materials and methods

The study is a case series describing outcomes for labour induction abortion for foetal anomalies, at gestational age 24 weeks and beyond. A systematic review was performed, searching PubMed, Embase, and Cochrane databases. Two independent authors reviewed and quality assessed the data from the articles.

Results

During a two-year period, 15 patients met inclusion criteria. Fourteen patients received mifepristone and misoprostol, and one received oxytocin. All delivered vaginally. Thirteen patients delivered within 24 hours of the first misoprostol dose, and half delivered within 12 hours. The average interval from misoprostol initiation to foetal expulsion was 15.5 hours in our series. The systematic review identified nine articles for inclusion, all retrospective studies. Labour induction protocols for mifepristone-misoprostol, reporting of gestational age, and key comparisons varied greatly.

Conclusions

The case series illustrates successful termination of pregnancy primarily using combined mifepristone-misoprostol. Certainty of current evidence is low, based on the GRADE framework. Future research is necessary on third-trimester outcomes with mifepristone-misoprostol.

摘要

目的:在某些情况下, 有些女性在妊娠后半期因胎儿畸形而选择终止妊娠。本报告提供了此类病例临床管理的客观信息, 并系统回顾了应用米非司酮-米索前列醇进行妊娠晚期流产引产结局的文献。

材料和方法:该研究是一个病例系列, 描述妊娠24周及以上因胎儿畸形而引产流产的结局。通过搜索PubMed、Embase和Cochrane数据库, 进行了系统综述。两名独立作者对文章中的数据进行了审核和质量评估。

结果:两年期间15例患者符合纳入标准。14名患者接受米非司酮和米索前列醇引产, 1名患者接受催产素引产。所有患者均经阴道分娩。13名患者在首次服用米索前列醇后24小时内分娩, 一半患者在12小时内分娩。本研究中, 从服用米索前列醇开始到胎儿娩出的平均时间间隔为15.5小时。该系统综述纳入了9篇文章, 均为回顾性研究。报道中米非司酮-米索前列醇引产方案、孕龄和关键比较差异很大。

结论:病例系列表明成功终止妊娠的病例主要应用米非司酮联合米索前列醇。基于GRADE框架, 当前研究的证据确定性等级较低。未来有必要对应用米非司酮-米索前列醇引产患者的晚期妊娠结局进行研究。

Keywords:

• Abortion
• second trimester
• third trimester
• labour induction
• mifepristone
• misoprostol

Acknowledgments

The authors sincerely thank Dr. Lee Shulman for his support and guidance during manuscript preparation.

Disclosure statement

Dr. Kiley is a consultant for CVS Health. The relationship poses no conflict of interest with the current research. The remaining authors report no conflicts of interest.

Additional information

Funding

Departmental funds were used to support the study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.