Midtrimester termination of pregnancy using gemeprost in combination with laminaria in women who have previously undergone cesarean section.
OBJECTIVE
We aimed to assess the efficacy and safety of midtrimester termination of pregnancy using gemeprost in combination with laminaria in women who had previously undergone cesarean section and in women who had not.


METHODS
Between January 1999 and December 2006, we carried out a retrospective study of termination of pregnancy at 12-21 weeks of gestation at the University of Tsukuba Hospital. Termination of pregnancy was carried out by three-step uterine cervical dilation using laminaria followed by vaginal administration of 1 mg gemeprost every 3 h for up to four doses over 24 h.


RESULTS
A total of 173 women underwent midtrimester termination of pregnancy. The women were categorized into two groups: those who had previously undergone cesarean section (n = 26) (previous cesarean section group) and those who had not (n = 147) (control group). Seven women had undergone cesarean section at least twice. The gemeprost dose administered was 2.8 +/- 1.4 mg for the previous cesarean section group and 2.4 +/- 1.6 mg for the control group (difference in doses not significant). Although abnormal vaginal bleeding (>500 mL) was more likely to occur in the previous cesarean section group than in the control group (odds ratio, 2.61; 95% confidence interval, 0.63-10.82), none of the woman required blood transfusion. Uterine rupture and failed abortion were not observed.


CONCLUSIONS
The efficacy and safety of our laminaria-gemeprost protocol for termination of pregnancy during the midtrimester are similar for women who have previously undergone cesarean section and those who have not.
Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan. manobata@md.tsukuba.ac.jp
Mana
M
Obata-Yasuoka
Hiromi
H
Hamada
Hideki
H
Watanabe
Rena
R
Shimura
Maki
M
Toyoda
Hiroya
H
Yagi
Kinuko
K
Takeshima
Kanako
K
Abe
Yoshiko
Y
Nakamura
Tsuyoshi
T
Ogura
Yutaka
Y
Fujiki
Hiroyuki
H
Yoshikawa
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000328:Adult; D000527:Alprostadil / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002585:Cesarean Section; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007795:Laminaria; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; C021182:gemeprost; D000527:Alprostadil