Termination Of Second Trimester Pregnancy Research Articles

Comparing the outcomes of termination of second trimester pregnancy with a live fetus using intravaginal misoprostol between women with and without previous cesarean section

ObjectiveTo 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).MethodsA 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.ResultsA 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.ConclusionIntravaginal 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.SynopsisIntravaginal 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.

Extra-amniotic saline instillation versus combination of oral mifepristone and vaginal misoprostol for second trimester termination of pregnancy in women with previous one caesarean section: A randomized controlled trial

Background: To study and compare the efficacy and safety of extra-amniotic saline instillation (EASI) and combination of oral mifepristone and vaginal misoprostol for second trimester termination of pregnancy in women with previous one caesarean section.Methods: This randomized controlled trial was conducted in Puducherry, South India. Pregnant women aged 18-45 years with history of previous one caesarean section at 16-27+6 weeks of gestation admitted for pregnancy termination were randomized to receive EASI or combination of oral mifepristone and vaginal misoprostol. Efficacy and safety were compared between the groups in an intention-to-treat analysis.Results: There were 50 patients randomized to the EASI (n=25) and oral mifepristone + vaginal misoprostol (n=25) groups. The median induction to abortion interval was 48 vs 60 hours (p value=0.029), need for another method of termination was 16% vs 44% and side effects were 36% vs 8% with combination of oral mifepristone and vaginal misoprostol in comparison to EASI.Conclusion: Combination of oral mifepristone and vaginal misoprostol appears to be more effective than EASI in reducing the induction-abortion interval, need for another method of termination and duration of hospital stay. The maternal safety profile appears to be comparable but requires further studies.

Placenta Accreta Spectrum Disorders - The Impact of the Creation of a Multidisciplinary Team on Maternal Outcomes in Portugal.

To describe a cohort of placenta accreta spectrum (PAS) cases from a tertiary care institution and compare the maternal outcomes before and after the creation of a multidisciplinary team (MDT). Retrospective study using hospital databases. Identification of PAS cases with pathological confirmation between 2010 and 2021. Division in two groups: standard care (SC) group - 2010-2014; and MDT group - 2015-2021. Descriptive analysis of their characteristics and maternal outcomes. During the study period, there were 53 cases of PAS (24 - SC group; 29 - MDT group). Standard care group: 1 placenta increta and 3 percreta; 12.5% (3/24) had antenatal suspicion; 4 cases had a peripartum hysterectomy - one planned due to antenatal suspicion of PAS; 3 due to postpartum hemorrhage. Mean estimated blood loss (EBL) was 2,469 mL; transfusion of packed red blood cells (PRBC) in 25% (6/24) - median 7.5 units. Multidisciplinary team group: 4 cases of placenta increta and 3 percreta. The rate of antenatal suspicion was 24.1% (7/29); 9 hysterectomies were performed, 7 planned due to antenatal suspicion of PAS, 1 after intrapartum diagnosis of PAS and 1 after uterine rupture following a second trimester termination of pregnancy. The mean EBL was 1,250 mL, with transfusion of PRBC in 37.9% (11/29) - median 2 units. After the creation of the MDT, there was a reduction in the mean EBL and in the median number of PRBC units transfused, despite the higher number of invasive PAS disorders.

Clinical analysis of prophylactic uterine artery embolization combined with double balloon catheter for second-trimester pregnancy termination in cases of complete placenta previa: A retrospective study.

Complete placenta previa often causes significant bleeding in a short period during second-trimester pregnancy termination. This can destabilize the mother's circulation, threatening her life. Furthermore, the condition is complicated by an immature cervix, making it a challenging clinical problem. The aim of this study was to investigate the effect of prophylactic uterine artery embolization (UAE) combined with double balloon catheter (DBC) deal with those cases. A total of 7 patients who underwent pregnancy termination in the second-trimester in Maternal and Child Health Hospital of Hubei Province between March 1st, 2021 and August 31st, 2023 were retrospectively analyzed in this study. All patients were diagnosed with complete placenta previa status and placenta accreta spectrum, and were treated with prophylactic UAE combined with DBC, and/or dilation and evacuation. All the patients received mifepristone, and 5 of them underwent medical termination with ethacridine lactate. Following prophylactic UAE combined with DBC, 6 patients underwent dilation and evacuation, which was monitored by ultrasound. And one patient experienced natural delivery of their fetus and placenta. Only one patient (patient 3) developed an intrapartum fever after prolonged duration of 18 hours from ethacridine to UAE and 56 hours from UAE to DBC. The amount of intrapartum hemorrhage ranged from 20 mL to 300 mL. The combined therapy of prophylactic UAE and DBC is a preferred option for patients with complete placenta previa undergoing second-trimester pregnancy termination. The use of dilation and evacuation may depend on the cervical condition, bleeding, or infection.

Clinical analysis of the regimens for terminating the second-trimester pregnancy in cesarean section women

Objective To explore the suitable regimens of induced termination of second-trimester pregnancy in women with prior cesareans. Methods A total of 204 s-trimester pregnant women with prior cesareans at the Third Affiliated Hospital of Zhengzhou University from January 2019 to December 2020 were included in this retrospective study. Group A included pregnant women who were administered mifepristone with misoprostol, Group B included those administering mifepristone with misoprostol as well as a transcervical Cook double-balloon catheter, Group C included those receiving mifepristone with an intra-amniotic injection of ethacridine lactate, and Group D included those receiving mifepristone, transcervical Cook double-balloon catheter, and intra-amniotic injection of ethacridine lactate. Their characteristics, clinical outcomes, and complications among the four groups were compared. Results All women had similar profiles in maternal age, gravidity, and previous cesarean delivery (p > .05). There was no significant difference in successful abortion among the four groups (p > .05). Group C had a significantly shorter induction-to-abortion interval than Group D (p < .01). The blood loss after abortion at 2 h in Group B was much less than Group A (p < .05). It made a significant difference between Group B and Group D regarding the blood loss after abortion at 2 h (p < .01). With regard to total incidences of adverse reactions, there were much fewer in the group B than the group A (p < .05). Conclusion The four regimens are all effective for the termination of second-trimester pregnancy in women with prior cesareans. The use of transcervical Cook double-balloon could reduce the risks caused by misoprostol, and the combination of these is feasible to induce second-trimester pregnancy termination in women with prior cesareans.

Mifepriston fore safe pregnancy termination in 2nd trimester

Mifepristone has been developed to antagonize the action of progesterone, and hasarecognizedroleinthemedicalterminationofpregnancy.Itsmedicaleffectshas a recognized role in the medical termination of pregnancy. Its medical effects reflectnotonlyonpregnancyterminationduringthefirstweeks,butsuccessfullyrefl ect not only on pregnancy termination during the fi rst weeks, but successfully maybeusedforinductionofabortioninthesecondtrimesterofpregnancyandmay be used for induction of abortion in the second trimester of pregnancy and forlaborinduction.Additionally,Mifepristonemaybeeffectiveaspainarrestfor labor induction. Additionally, Mifepristone may be effective as pain arrest medicineduringlabor.DeterminingtheroleofMifepristoneincervixripeningmedicine during labor. Determining the role of Mifepristone in cervix ripening inthesecond-trimesterpregnancyterminationandevaluatingitsefficacyaspainin the second-trimester pregnancy termination and evaluating its effi cacy as pain killermedicine.Theresearchincluded19-41yearsold195womenwiththeneedkiller medicine. The research included 19-41 years old 195 women with the need forpregnancyterminationinthesecondtrimester.Thegroupswedividedintofor pregnancy termination in the second trimester. The groups we divided into mifepristoneandFollyballoongroups,usedasacontrol.Mifepristonewasusedmifepristone and Folly balloon groups, used as a control. Mifepristone was used inanattemptatcervicalripening.TheefficacyofMifepristonewasassessedin an attempt at cervical ripening. The effi cacy of Mifepristone was assessed usingthedegreeofcervicalripeningandbythescaleofpainseverity(APS).Inusing the degree of cervical ripening and by the scale of pain severity (APS). In theMifepristonegroupthepatientsstayinthehospitalwasreducedcomparedthe Mifepristone group the patients stay in the hospital was reduced compared tothefollyballoongroup.Thepainscorewassignificantlylowinpatientsusingto the folly balloon group. The pain score was signifi cantly low in patients using Mifepristoneasapainkillermedicine.InmaingroupthepainlevelwithmiwasMifepristone as a painkiller medicine. In main group the pain level with mi was 4,5-5andwithafollyballoon–7,9-9.Mifepristoneiseffectiveinmaturingthe4,5-5 and with a folly balloon – 7,9-9. Mifepristone is effective in maturing the cervixforlateabortionandforlabor.Consideringthelackofcases,thestudiescervix for late abortion and for labor. Considering the lack of cases, the studies mustbecontinuedinthisconnection.must be continued in this connection.

Randomised Control Study of Misoprostol and Mifepristone versus Misoprostol Alone in Second Trimester Termination of Pregnancy.

This study was done to assess and compare the efficacy and safety of mifepristone and misoprostol combination versus misoprostol alone for second trimester termination of pregnancy in relation to induction abortion interval, average amount of misoprostol required in each group, success rate and side effects. This randomised control study was conducted on 100 women admitted in the Department of Obstetrics & Gynaecology, S.C.B. Medical College & Hospital, Cuttack, for second trimester termination of pregnancy, divided into two groups, Group A and Group B of 50 patients each. Group A patients received 200mg of oral mifepristone followed by 400mcg of vaginal misoprostol after 48h, and then 400 mcg of vaginal misoprostol every 3 hourly until complete expulsion or up to a maximum of 6 doses. Group B patients received 400mcg of vaginal misoprostol every 3 hourly until complete expulsion or up to maximum 6 doses. Complete abortion was seen in 92% and 72% cases in Group A and Group B, respectively. Mean induction abortion interval was 11.59 ± 2.71h in Group A and 15.57 ± 2.27h in Group B (p value < 0.001). The average dose of misoprostol required was less in combination regimen, i.e. 1128 ± 384mcg compared to 1680 ± 302mcg in misoprostol alone group (p value < 0.001). Side effects like nausea, vomiting and diarrhoea were less in combination regimen than misoprostol alone group. Mifepristone and misoprostol combination is more effective and safer alternative than misoprostol alone in second trimester termination of pregnancy.

The effect of induction duration on postabortal hemorrhage in second-trimester pregnancy termination with misoprostol

Objective: The aim was to investigate how the duration of induction affects postabortion hemorrhage in second-trimester pregnancy terminations using misoprostol. Methods: This single-center retrospective cohort study was conducted between April 2020 and April 2021 at a university hospital. Singleton pregnant women having gestational age of 13–26 weeks and being hospitalized for termination were included in the study. The misoprostol was administered 200 µg every 4 hours intravaginally to patients already diagnosed with miscarriage, and 400 µg every 3 hours to all remaining patients. Estimated blood loss volume (EBLV) was calculated using a formula previously defined by Stafford et al. A total of 117 singleton pregnant women having gestational age of 13–26 weeks and being hospitalized for pregnancy termination were included in the study. Of these, 78 patients aborted within 0–24 hours (Group 2). The remaining 39 patients aborted in more than 24 hours (Group 1). Results: The EBLV was higher in the study group (p=0.003). In addition, the rate of patients with ≥500 cc and ≥1000 cc blood loss was also significantly higher in the study group (p values 0.049 and 0.016, respectively). After adjusting for potential confounder factors, the probability of blood loss of ≥500 cc and ≥1000 cc was found to be higher in the study group (adjusted OR: 2.720, 95% CI: 1.12–6.58 and adjusted OR: 6.987, 95% CI: 1.25–38.98, respectively). Conclusion: Postabortion hemorrhage risk was found to be higher in patients whose induction period lasted longer than 24 hours in second-trimester terminations with misoprostol. However, there was no deterioration in the patient’s clinical status and no increase in transfusion rates. Care should be taken with regard to vaginal bleeding in misoprostol applications lasting longer than 24 hours.

A comparative study of second trimester termination of pregnancy with mifepristone and misoprostol vs misoprostol alone in 50 cases

The aim: To study the efficacy and safety of combined mifepristone and misoprostol used in second-trimester abortion(≥ 12 and ≤ 20 weeks) in comparison with only vaginal misoprostol.&#x0D; Materials and methods: This study was a prospective comparative randomised clinical study in women attending hospitals in need of a second-trimester abortion, i.e., 12–20 weeks of pregnancy were taken up and divided as Group A – 50 women with mifeprisptone and misoprostol, Group B – 50 women with misoprostol alone Results were analysed according to age, parity, gestational age, average dose of misoprostol required for complete abortion, Induction abortion interval, completeness of abortion, side effects and mean days of hospital stay.&#x0D; Results: Demographic details are comparable and insignificant in the comparison. The average dose of misoprostol (mcg) required for the completeness of abortion in group A is 596±28.28 mcg, and in group B, it is 1148±160.66 mcg (p&lt;0.001) which is statistically significant. In the present study, the induction abortion interval is significantly less in group A compared to group B, with p&lt;0.001. In addition, 10 out of 50 patients in group A aborted within 7 hours, whereas none in group B. Mean duration of hospital stay in group A is 24 hours. In group B, it is 34.82 hours which is statistically significant with a p-value of &lt;0.001. 12 patients in group A and 26 in group B had side effects like nausea, vomiting, fever, headache and diarrhoea. 8 % of group A and 20 % of group B had a fever. These patients were treated with antipyretics. 6 % in group A and 14 % in group B had nausea and vomiting and were treated with antiemetics. 4 % in group A and 8 % in group B had diarrhoea and were treated with antimotility drugs. 6 % in group A and 10 % in group B had a headache; these patients were treated with NSAIDs.&#x0D; Conclusions: The combination of mifepristone and misoprostol is a highly effective and safe method for second-trimester termination of pregnancy. The amount of misoprostol needed to accomplish the abortion, and the severity of the adverse effects are lower in the mifepristone-primed group than in the misoprostol-alone group. Since there are fewer difficulties, this approach can be employed in hospitals with high patient density.

Vaginal misoprostol versus combined intracervical foley’s catheter and oxytocin infusion for second trimester pregnancy termination in women with previous caesarean sections: a randomised control trial

Second trimester pregnancy termination has been reported to be associated with 3–5 times higher maternal morbidity and mortality risks more than first trimester termination. Medical methods had been thoroughly assessed and it is considered the anchor of the safe abortion care. Howevere, there is no global agreement regarding the ideal method for induction of the second trimester abortion in a scarred uterus. The aim of this study was to achieve vaginal expulsion in an expeditious manner with less maternal complications. A total of 158 women having, a history of previous caesarean section undergoing second trimester pregnancy termination, were randomly allocated into group (1) vaginal misoprostol group (n = 79) or group (2) combined intracervical foley’s catheter plus intravenous oxytocin infusion group (n = 79). The primary endpoint was complete fetal expulsion. Meanwhile, secondary outcomes were the rates of maternal complications, in terms of the need for surgical evacuation of retained product of conception (ERPOC), severe haemorrhage, uterine rupture, blood transfusion, cervical laceration, diarrhoea, vomiting and fever. The registration number of this trial https://clinicaltrials.gov/ct2/show/NCT04501809. This study showed that the combined use of intracervical foley’s catheter and oxytocin is an effective, and safe alternative to vaginal misoprostol for termination of the second trimester pregnancy in women having a previous caesarean delivery. Impact statement Why was this study conducted? The purpose of this study is to achieve an expeditious delivery for second trimester pregnancy termination in a scarred uterus by combined mechanical and pharmacological methods without significant morbidity. Physicians should balance the benefit of achieving vaginal exlpusion in an expeditious manner versus the risk of uterine rupture or any other maternal complications. What does this add to what is known? This study showed that a combined mechanical and pharmacolohical approach for second trimester termination of pregnancy has comparable efficacy and safety to vaginal misoprostol which is more affordable to the low resources countries where termination of pregnancy in a scarred uterus still has an increased maternal morbidity. What is the implication of this study on clinical practice? The combined use of intracervical foley’s catheter with intravenous oxytocin infusion is a safer option than vaginal misoprostol with less serious maternal complications.

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

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.

Clinical Utility of Mifepristone: Apprising the Expanding Horizons

Mifepristone is a progesterone and glucocorticoid receptor antagonist. Medical abortion with mifepristone and prostaglandin has revolutionized the abortion process extending abortion care to the doors of females. From as low as 2 mg/day to doses extending to 600 mg, from daily dosing to single dosage treatment, mifepristone has a wide perspective in the treatment of various pathologies. Cervical dilatation and myometrial contractility have made the utility of mifepristone feasible for second-trimester termination of pregnancy and induction of labor awaiting Food and Drug Administration approvals. Its anti-progesterone action on the menstrual cycle has a new dimension of use as a contraceptive, as well as use as a menstruation inductive agent. Its role in endometriosis, ectopic pregnancy, and adenomyosis requires more intensive research. Apoptotic action of mifepristone, interference of heterotypic cell adhesion to the basement membrane, cell migration, growth inhibition of various cancer cell lines, decreased epidermal growth factor expression, suppression of invasive and metastatic cancer potential, increase in tumor necrosis factor, downregulation of cyclin-dependent kinase 2, B-cell lymphoma 2, and Nuclear factor kappa B have opened its potential to be explored as anti-cancer treatment and its effects on leiomyoma. The drug needs to be studied more for the prospectus of its anti-glucocorticoid actions in a wider dimension beyond its acquiescence for the treatment of Cushing syndrome.

Mifepristone-misoprostol versus misoprostol alone for second trimester termination of pregnancy in a tertiary hospital in Hong Kong

Mifepristone-misoprostol versus misoprostol alone for second trimester termination of pregnancy in a tertiary hospital in Hong Kong

Termination of pregnancy in the second trimester- the course of different therapy regimens.

To compare two prostaglandin analogs and two application intervals between mifepristone and the prostaglandin analog administration on the time to abortion in second trimester termination of pregnancy. Other endpoints were live birth rate and fetal lifetime after expulsion. Retrospective data of 373 abortions performed were evaluated. Four medical induction subgroups and two feticide subgroups were considered. The definition criteria of the subgroups were the choice of administered prostaglandin analog (misoprostol vs. sulprostone) and the time interval between mifepristone and prostaglandin analog administration (48 vs. 24h). The outcome parameters were the time to complete uterine evacuation (TCUE), the live birth rate and duration of fetal life. In the misoprostol subgroups, the median TCUE was 1.6h longer in the 24-h group than in the 48-h group (p=0.950). In the sulprostone subgroups, the median TCUE was 1.9h shorter in the 24-h group than in the 48-h group (p=0.950). The median TCUE was shorter for sulprostone than for misoprostol in all six subgroups (p<0.001). The rate of fetal live births ranged between 13.6and 15.9% within the medical induction subgroups (p=0.969). The median fetal lifetime was slightly shorter in the sulprostone groups than in the misoprostol groups (p=0.563). Both application intervals and prostaglandin analogs are similarly effective. The therapy regime should be adapted to the personal preferences of the woman, the situational and clinical conditions.

Accuracy and clinical utility of standard postmortem radiological imaging after early second trimester termination of pregnancy

ObjectiveThis study aims to assess accuracy and clinical utility of postmortem radiological exams [Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and Radiography (XR)] after termination of pregnancy at <23 weeks’ gestation for congenital fetal malformations in comparison to autopsy. Study designThis a prospective single-center study on fetuses underwent termination of pregnancy for fetal defects. Overall concordance between any radiological exam and autopsy was evaluated. For postmortem MRI only, the following subgroups were analyzed: 1) total agreement; 2) agreement for main findings; 3) agreement for main findings but major relevant additional findings at autopsy; 4) total disagreement. Results174 cases were collected. The overall concordance with autopsy for main findings was 71% (115/163) for postmortem MRI and 99% (173/174) for prenatal ultrasound (US). Postmortem MRI detection rate was high for central nervous system (CNS) defects (98%), gastrointestinal, genitourinary and respiratory defects (100%), while it was poor for cardiovascular and musculoskeletal defects (25% and 42%, respectively). For musculoskeletal abnormalities, the performance of postmortem XR and postmortem CT exams improved the detection rate from 42% for postmortem MRI alone to 92%. ConclusionsPostmortem MRI has a good overall concordance for fetal defects after termination of pregnancy performed at <23 weeks. Along with autopsy, postmortem MRI may be offered for all cases of CNS defects in order to prevent inconclusive exams due to autolysis of the brain tissue, while postmortem CT and postmortem XR are indicated for musculoskeletal defects. In the presence of multiple abnormalities or cardiac defects the couple should be counseled on the poor performance of radiological investigations.

Vaginal versus intrauterine extra-amniotic administration of misoprostol for second-trimester pregnancy termination; a randomized clinical trial

Introduction: Misoprostol is a widely used prostaglandin to terminate pregnancy in the second trimester. The route of drug administration has a significant effect on the quality of treatment. Objectives: In this study, we aimed to compare efficacy and adverse effects of vaginal and intrauterine extraamniotic administration of misoprostol in second-trimester termination. Patients and Methods: In a randomized clinical trial, 112 women with an intrauterine fetal death between 13– 24 weeks of gestation attended Akbarabadi hospital were enrolled during 2018-2019. Patients were randomly divided into two groups. In group A, 200 µg misoprostol was diluted in 10ml of normal saline and administered extra-amniotic every 4 hours. Group B received vaginal tablets (200 µg in each) according to FIGO protocol. The primary outcomes were the time needed to expel gestational products and hemoglobin level changes. Results: In group A, conception product expulsion occurred within an average of 7.52 ± 0.29 hours, significantly faster than group B (12.02 ± 0.42 hours; P&lt;0.05). In group A, the Hemoglobin level decreased after intervention (-1.23 ± 1.20 g/dL), and the changes were more prominent than group B (-0.15 ± 0.51 g/dL; P&lt;0.05). Conclusion: For pregnancy termination, intrauterine extra-amniotic administration of misoprostol is a more effective method than the vaginal route in the second trimester. However, regarding further hemoglobin decrease in this method, its safety is still unclear and needs to be approved by further clinical trials with a larger sample size. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trial (identifier: IRCT20190606043830N1; https://en.irct.ir/trial/40184, ethical code: IR.IUMS.FMD.REC1396.941129004).

Diagnosis and treatment of uterine artery pseudoaneurysm: Case series and literature review.

Background:Uterine artery pseudoaneurysm (UAP) is a rare but potentially life-threatening cause of hemorrhage. Nonetheless, its knowledge could be insufficient among obstetricians, gynecologists, and radiologists. We aimed to clarify the clinical characteristics, management, and outcomes of UAP.Methods:We retrospectively analyzed nine female patients diagnosed with UAP at our institute between 2013 and 2020.Results:Seven cases presented with a history of traumatic surgery including cesarean section, dilation and curettage, laparoscopic myomectomy, and cervical conization. Two cases occurred after spontaneous vaginal delivery and second-trimester pregnancy termination. The main symptom was heavy/massive/prolonged vaginal bleeding. All patients were first evaluated by color Doppler ultrasonography and three cases were confirmed by magnetic resonance imaging. Severn patients underwent transarterial embolization (TAE) of the uterine arteries, and two were managed conservatively. All patients had good outcomes.Conclusions:UAP can develop after traumatic pelvic operations and non-traumatic delivery/abortion. It may be more common than previously considered. The risk of rupture may be correlated with multiple factors other than the mass size. TAE of the uterine artery could be an effective management strategy for ruptured UAP. However, some cases can resolve spontaneously without TAE, suggesting that conservative management can be employed in some women.

VP15.03: Correlation between prenatal ultrasound and fetal autopsy findings: a retrospective study of second trimester termination of pregnancy

VP15.03: Correlation between prenatal ultrasound and fetal autopsy findings: a retrospective study of second trimester termination of pregnancy

INTRA-VAGINAL MISOPROSTOL ALONE VS MISOPROSTOL IN COMBINATION WITH INTRA-CERVICAL FOLEY’S CATHETER FOR SECOND TRIMESTER ABORTION: A COMPARATIVE STUDY

Pregnancy termination in the second trimester is riskier than in the first. The primary objective is to create a more effective means of termination while also reducing induction time. To compare the efficacy, safety, and acceptability of intra-cervical foley's catheter with vaginal misoprostol versus vaginal misoprostol for second-trimester pregnancy termination. This clinical study involved 400 pregnant women who were scheduled to have their pregnancy terminated between 13 and 22 weeks of pregnancy for any reason. The enrolled women were divided into two categories: Category I (Misoprostol category): intra-cervical Foley’s catheter inserted with a standard regimen of moistened misoprostol tablets (400 g) 4 hourly inserted vaginally to a maximum of 5 doses; Category II (Combined category): intra-cervical Foley catheter inserted with a standard regimen of moistened misoprostol tablets (400 g) 4 hourly inserted vaginally to a maximum of 5 doses 4 hourly intra-vaginal injections were employed. Misoprostol was retained in the posterior fornix, and the dose was repeated every 4 hours until the catheter was removed, or until a maximum of five doses had been administered. The mean induction to abortion interval in the misoprostol category was 15.38 + 1.25 hours and 8.25 + 2.25 hours in the combination category, which was statistically significant (p= 0.001). The misoprostol category had a 94 percent success rate, while the combined category had a 97 percent success rate. The use of a combined intra-cervical foley's catheter and vaginal misoprostol to end a pregnancy in the second trimester is a novel, safe, effective, and acceptable procedure.

Clinical analysis of second-trimester pregnancy termination after previous caesarean delivery in 51 patients with placenta previa and placenta accreta spectrum: a retrospective study

BackgroundsPregnancy termination during the second trimester in patients with placenta previa and placenta accreta spectrum (PAS) is a complex and challenging clinical problem. Based on our literature review, there has been a relative increase in the number of such cases being treated by hysterotomy and/or local uterine lesion resection and repair. In the present study, a retrospective analysis was conducted to compare the clinical outcomes when different management strategies were used to terminate pregnancy in the patients with placenta previa and PAS.MethodsA total of 51 patients who underwent pregnancy termination in the second trimester in Beijing Obstetrics and Gynecology Hospital between June 2013 and December 2018 were retrospectively analyzed in this study. All patients having previous caesarean delivery (CD) were diagnosed with placenta previa status and PAS.Results① Among the 51 patients, 16 cases received mifepristone and misoprostol medical termination, 15 cases received mifepristone and Rivanol medical termination, but 1 of them was transferred to hysterotomy due to failed labor induction, another 20 cases were performed planned hysterotomy. There was no placenta percreta cases and uterine artery embolization (UAE) was all performed before surgery.② There were 31 cases who underwent medical termination and 30 cases were vaginal delivery. Dilation and evacuation (D&E) were used in 20 cases of medical abortion failure and in all 30 cases of difficult manual removal of placental tissue. ③ A statistically significant difference was found among the three different strategies in terms of gestational weeks, the type of placenta previa status, main operative success rate and β-HCG regression time (P < 0.05). ④ There were 4(7.8%) cases who were taken up for hysterectomy because of life-threatening bleeding or severe bacteremia during or after delivery and hysterotomy. The uterus was preserved with the implanted placenta partly or completely left in situ in 47(92.2%) cases. Combined medical and/or surgical management were used for the residual placenta and the time of menstrual recovery was 52(range: 33 to 86) days after pregnancy termination.ConclusionsTerminating a pregnancy by vaginal delivery through medical induction of labor may be feasible if clinicians have an overall understanding of gestational age, the type of placenta previa status, the type of placenta accreta, and patients concerns about preserving fertility. A collaborative team effort in tertiary medical centers with a very experience MDT and combined application of multiple methods is required to optimize patient outcomes.