ABORTION IN THE SECOND TRIMESTER OF PREGNANCY

Abstract

Medical abortion has revolutionized access to quality abortion services in obstetrics and gynecology. However, the issues of termination in the second trimester of pregnancy in women with a uterine scar still remain controversial. The urgency of the problem is associated with such a serious obstetric complication as uterine rupture along the scar. Objective. To evaluate the effectiveness and safety of medical abortion in patients at 18-22 weeks of pregnancy. Materials and methods. A prospective cohort study was conducted without blinding (pregnant women and doctors knew which method was used to terminate the pregnancy). 15 patients were included in the gestational age of 18-22 weeks, including 7 with a uterine scar after a previous cesarean section. For the purpose of medical termination of pregnancy, a combination of mifepristone and misoprostol was used. A clinical and statistical assessment of the obtained data was carried out. Results. The total duration of abortion after taking misoprostol was on average 9.5 (95% CI 8.346-10.168) hours and did not differ in the group of pregnant women with a uterine scar - 9.8 (95% CI 9.346-10.202) hours and without a uterine scar - 9.6 (95% CI 9.356-10.217) hours (p>0.05). The volume of blood loss was in the range of 180.0 (95% CI 150.0–200.0) ml. A positive effect was achieved in 100% of cases. Pathology associated with the separation of the placenta was identified in 2 (13.3%) cases in the presence of a scar on the uterus after cesarean section. Conclusion. The presence of a previous uterine scar after cesarean section did not affect the duration of abortion. In most cases, for successful termination of pregnancy at 18-22 weeks, the maximum dose of oral misoprostol was 1200 mcg.