Different methods of termination of second trimester pregnancy with scarred uterus at Mansoura University Hospitals | ||||
| The Egyptian Journal of Fertility of Sterility | ||||
| Article 4, Volume 24, Issue 2 - Serial Number 11106352, May 2020, Page 27-34 PDF (2.75 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/egyfs.2020.105466 | ||||
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| Author | ||||
| Rafik Ibrahim Barakat | ||||
| Assistant professor of Obstetrics and Gynecology Mansoura Faculty of Medicine, Mansoura University Postcode number: 35111 El- Gomhoria street-Mansoura-Egypt. | ||||
| Abstract | ||||
| Objective: To describe different methods used in termination of sec- ond trimester pregnancy in those with previous uterine scare(s) and compare their efficacy and safety at a tertiary care center. Patients and Methods: a prospective, randomizedcontrolled com- parative trial conducted at Mansoura University Hospitals, Egypt during February 2018 through March 2019 and involved 105 healthy pregnant women at 14-28 weeks of gestation diagnosed to have missed abortion or intrauterine fetal death with a previous one or more caesarean delivery (CD). They divided into 3 equal groups, GI; received misoprostolalone for termination of pregnancy via ei- ther vaginal or sublingual routes as 400 µg / 6 hours for pregnancy at 14- 20 weeks; 200 µg / 6 hours for pregnancy at 20 -25 weeks or 100 µg / 6hours at 26 -27 weeks; G (II) for whom a Foley’s catheter was inserted under complete aseptic precautions, passed beyond the internal os then its balloon inflated by 20-30 ml normal saline for pregnancy at 14 - 20 weeks; 40-50 ml for pregnancy at 20 - 27 weeks and its position was confirmed by TAS then oxytocin infusion was commenced after the catheter expulsion, GIII; involved women who received a combination of Foley’s catheter inserted intracervical and a misoprostol dose 200 µg for pregnancy from 14-20 weeks or 100 µg for those between 20-27 weeks that was dissolved in 30 ml saline and injected intrauterine through the catheter lumen. Any of the pre- vious method continued for 24 hours otherwise the fetus comes out earlier. All patients in the three groups received oxytocin infusion 20 units in 500 ml normal saline after fetal expulsion to avoid placental retention and post-abortive bleeding.The primary outcome was in- duction-to-abortion interval (IAI) plus the mean time (SD) needed for complete uterine evacuation. Results: The patients’ characteristics and baseline data for the three groups including the age, weight, gravidity, parity, duration of preg- nancy, number of previous scar(s) showed no significant difference (p > 0.05).Studying the mean (SD) of IAI/hourtogether with data ob- served after starting treatment and postoperative complications record- ed a significant difference among the three groups as regard IAI (being shortest in GIII;11.6 ±2.6, longest in GII; 17.3 ±3.4 and in between for GI;15.9 ±3.4 respectively; P< 0.001), the success rate (100% for GIII, 91.4 % for GI and 85.7% for GII, p 0.02) and the occurrence of diar- rhea being lowest in GII (no cases), highest in GI (5 cases) in compare to 1 case only recorded in GIII (P0.024). On the other hand, insignif- icant difference among the study groups was observed as regard the mean (SD) of time/minutes needed for placenta expulsion after the fetal descent being 31.09 ± 5.01, 27.8 ± 7.61 and 26.57 ± 12.17 for the three groupsrespectively, the occurrence of post induction nausea and vomiting, fever or post-evacuation bleeding (p> 0.05). Somecases needed MVA after placental expulsion (6 cases in GI, 7 cases in GII and 4 in GIII) but again with no significant difference. Conclusion:Combined use of misoprostol and Fo- ley’s catheter for termination of mid-trimester preg- nancy with previous uterine scar(s) is found more superior than the use of either method alone regard- ing the success rate and shorter duration with mini- mal non serious complications and side effects. | ||||
| Keywords | ||||
| mid-trimester; pregnancy; termination | ||||
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