title: Second- and third-trimester management of medical termination of pregnancy and fetal death in utero after prior caesarean section.
abstract: OBJECTIVE
  To evaluate the results and risks of a protocol for second- and third-trimester termination of pregnancy after prior caesarean section.
  
  
  METHODS
  This is a retrospective study, conducted in a level 3 (university hospital) maternity unit between January 2001 and September 2008. 67 women with a history of caesarean section underwent second- and third-trimester termination of pregnancy. The protocol was administration of 600 mg mifepristone the first day and application of laminaria tents the second day. One the third day, 48 h after mifepristone, two 200 μg tablets of misoprostol were given orally every 3 h until delivery. Epidural analgesia was performed routinely. Complications analysed were uterine rupture, labour lasting over 12 h, and bleeding requiring blood transfusion.
  
  
  RESULTS
  Delivery was vaginal in 64 cases (95.5%), a median 4 h 20 min (P25: 3 h 5 min, P75: 7 h 7 min) after administration of misoprostol (median number of tablets 2; P25: 2, P75: 4). The median number of tablets of misoprostol was significantly higher for termination of pregnancy than for fetal death in utero (4 vs. 2; p=0.002). The rate of uterine rupture was 4.8% [95% CI: 1.2-14.2]. Bleeding during delivery requiring a transfusion occurred in 2 cases (3.0%; 95% CI: 0.5-11.3).
  
  
  CONCLUSIONS
  A high rate of vaginal delivery was achieved at low doses of misoprostol, with a short median induction-to-delivery interval, and a rate of uterine rupture higher than that observed during attempted vaginal delivery at term in a caesarean scar pregnancy. The rate of severe bleeding during delivery was low.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, University Hospital, Montpellier, France. melaniecayrac@hotmail.fr
authors.forename: Mélanie
authors.initials: M
authors.lastname: Cayrac
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Faillie
authors.forename: Anaïg
authors.initials: A
authors.lastname: Flandrin
authors.forename: Pierre
authors.initials: P
authors.lastname: Boulot
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage; D000028:Abortion, Induced / Q000379:methods*; D000284:Administration, Oral; D000328:Adult; D002585:Cesarean Section; D004305:Dose-Response Relationship, Drug; D005260:Female; D005313:Fetal Death / Q000139:chemically induced*; D006801:Humans; D015735:Mifepristone / Q000008:administration & dosage*; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014597:Uterine Rupture / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone