Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
BMC Pregnancy Childbirth. 2024 Apr 12;24(1):274. doi: 10.1186/s12884-024-06442-x.
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).
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.
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.
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.
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.
比较有剖宫产史（PCS）和无剖宫产史（无 PCS）的孕妇在使用 400μg 米索前列醇经阴道每 6 小时给药 1 次以终止妊娠时，中期妊娠（14-28 周）活胎妊娠的结局。
对清迈大学医院中期妊娠终止的前瞻性数据库进行了一项比较研究。纳入标准包括：（1）单胎妊娠；（2）妊娠 14-28 周；（3）妊娠有活胎且有医学指征终止。将参与者分为两组；PCS 组和无 PCS 组。所有患者均采用米索前列醇 400μg 经阴道每 6 小时给药 1 次终止妊娠。主要结局为引产至分娩的时间间隔和成功率，定义为 48 小时内分娩。
共纳入 238 例孕妇，其中 80 例 PCS，158 例无 PCS。两组 48 小时内分娩成功率无统计学差异（91.3%比 93.0%；p 值 0.622）。引产至分娩的时间间隔也无统计学差异（1531 分钟比 1279 分钟；p 值>0.05）。妊娠周数是成功率和米索前列醇用量的独立因素。米索前列醇最常见不良反应的发生率相似。1 例（1.3%）PCS 组孕妇在终止妊娠时发生子宫破裂，最终安全成功地进行了手术切除和子宫修复。
经阴道给予米索前列醇对有 PCS 和无 PCS 的中期妊娠终止均有效，成功率和引产至分娩的时间间隔相似。妊娠周数是成功率和米索前列醇用量的独立因素。1.3%的 PCS 孕妇可能发生子宫破裂，提示必须高度警惕早期发现和适当处理。
有剖宫产史和无剖宫产史的孕妇使用米索前列醇经阴道给药终止中期妊娠，成功率相近，均非常有效，且前者发生子宫破裂的风险为 1.3%。
