title: Misoprostol use for second-trimester termination of pregnancy among women with one or more previous cesarean deliveries.
abstract: OBJECTIVE
  To establish the safety and efficacy of misoprostol for second-trimester termination of pregnancy among women with one or more previous cesarean deliveries.
  
  
  METHODS
  In a retrospective study, data were reviewed from women attending a reproductive health clinic in Bloemfontein, South Africa, for second-trimester termination between 2010 and 2013. The study group, comprising women with one or more previous cesareans, was compared with a control group, comprising women with no previous cesarean or uterine scarring. Procedure-specific information was compared, including misoprostol use, termination duration, need for other methods (e.g. oxytocin), placenta delivery, termination outcome, and bleeding.
  
  
  RESULTS
  The study group comprised 268 women: 231 (86.2%) with one and 37 (13.8%) with two previous cesareans. The control group comprised 266 women. Incomplete abortion was recorded in 223 (85.4%) of 261 women in the study group and 213 (80.4%) of 265 in the control group. The number of women with retained placenta was higher in the study than in the control group (158/261 [60.5%] vs 146/265 [55.1%]; P<0.001). Severe bleeding was observed only in the control group (7/266 [2.6%]). No uterine rupture was observed.
  
  
  CONCLUSIONS
  Misoprostol was safe for second-trimester termination among women with previous cesareans; however, the efficacy of the local regimen was reduced owing to high placental retention.
authors.affiliation: Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
authors.forename: Martin
authors.initials: M
authors.lastname: Cuellar Torriente
authors.affiliation: Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
authors.forename: Wilhelm J
authors.initials: WJ
authors.lastname: Steinberg
authors.affiliation: Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
authors.forename: Gina
authors.initials: G
authors.lastname: Joubert
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Misoprostol; Previous cesarean delivery; Safety; Second-trimester termination of pregnancy; South Africa; Termination of pregnancy