The safety of misoprostol alone use for second-trimester termination of pregnancy in women with previous caesarean deliveries

Abstract

Purpose

To investigate the safety of misoprostol use in second-trimester pregnancy termination among women with previous caesarean sections.

Materials and methods

This is a retrospective cohort study conducted in a tertiary centre, examining 359 patients whose pregnancy was terminated with misoprostol alone between 14 and 24 weeks with the indication of foetal anomalies. Two dose regimens were administered vaginally or sublingually: (1)400 mcg misoprostol every 3–6 h; (2) 200 mcg misoprostol every 3–6 h following a loading dose of 400 mcg. The patients were divided into three groups according to the number of previous caesarean sections (CSs) and compared in terms of demographic and clinical characteristics and complications. Termination-related complications were the primary outcomes considered.

Results

Of the 217 patients, 80 (36.8%) had no previous uterine scar, 79 (36.4%) had one previous CS, and 58 (26.7%) had at least two prior CSs. The overall complication rate was 0.9%. There were no differences among groups in terms of complications (p > 0.05). There was no difference in complications in women with prior CS when they were compared according to the misoprostol regimens used (p > 0.05). The total dose of misoprostol used ranged from200 to 3,600 mcg. The treatment success of misoprostol during the second trimester was 92.1%. According to regression analysis, an increase in the week of gestation increased the failure rate of misoprostol for inducing second-trimester abortion by 2.7 times (95%CI (1.38–5.39)).

Conclusion

Misoprostol alone is a safe and effective option for terminating second-trimester pregnancies with one or more previous CSs in settings where mifepristone is unavailable.

摘要

目的：探讨米索前列醇用于有剖宫产史妇女孕中期终止妊娠的安全性。

材料和方法：这是一项在三级中心进行的回顾性队列研究, 对359名有胎儿畸形指征的14-24周内单用米索前列醇终止妊娠的患者进行了检查。阴道或舌下两种给药方案：（1）米索前列醇400微克, 每3∼6h一次, （2）负荷剂量400微克后, 每3∼6h给米索前列醇200微克。根据剖宫产（CSs）次数将患者分为三组, 并在人口学、临床特征和并发症方面进行比较。与终止妊娠相关的并发症是考虑的主要结果。

结果：217例患者中, 80例（36.8%）无瘢痕子宫, 79例（36.4%）有一次剖宫产史, 58例（26.7%）至少有两次剖宫产史。总的并发症发生率为0.9%。两组并发症发生率差异无统计学意义（p>0.05）。与米索前列醇方案比较, 既往有剖宫产史患者的并发症发生率无显著差异（p>0.05）。米索前列醇的总剂量从200微克到3600微克不等。米索前列醇在孕中期应用的成功率为92.1%。回归分析显示, 孕周的增加使米索前列醇引产失败率增加2.7倍（95%CI（1.38∼5.39））。

结论：在不可用米非司酮的情况下, 对有一次或多次剖宫产史的孕中期妇女单用米索前列醇终止妊娠是安全有效的选择。

Keywords:

• Second-trimester termination
• previous caesarean section
• misoprostol
• uterine rupture

Ethical approval

Bursa Yuksek Ihtisas Training and Research Hospital Ethics Committee, Protocol Number: 2011-KAEK-25 2021/01-11.

Author contributions

AE: conception or design of the work; analysis, interpretation of data for the work; Drafting the work.

BTK: interpretation of data for the work; analysis.

FNT: conception or design of the work; revising the work critically for important intellectual content.

BD: drafting the work, revising it critically for important intellectual content.

NKE: analysis, drafting the work, final approval of the version to be published.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.