ABORTION IN THE SECOND TRIMESTER OF PREGNANCY
DOI:
https://doi.org/10.54890/1694-8882-2024-2-128Abstract
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.
Keywords:
abortion in the second trimester of pregnancy, cesarean section, mifepristone, misoprostol, congenital fetal growth, preconception preparation.References
1. Bearak J, Popinchalk A, Ganatra B, Moller A-B, Tunçalp Ö, Beavin C, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob Health.2020;8(9):e1152-e1161. https://doi.org/10.1016/S2214-109X(20)30315-6
2. Whitehouse K, Brant A, Fonhus MS, Lavelanet A, Ganatra B. Medical regimens for abortion at 12 weeks and above: a systematic review and meta-analysis. Contracept X. 2020;2:100037. Published 2020 Aug 20. https://doi.org/10.1016/j. conx.2020.100037
3. Авдеев А. Анализ демографической ситуации в Кыргызстане: обновление 2020 г. Демографические вызовы в развитии Кыргызской Республики. Аналитическая записка. ЮНФПА; 2021. 32 с. Режим доступа:: https://kyrgyzstan. unfpa.org/sites/default/files/pub-pdf/rus_1.pdf
4. Кыргыз Республикасынын Улуттук статистикалык комитети. Аборттордун саны (учурлар). Жеткиликтүү: www.stat.kg/kg/opendata/category/262/
5. Асылбашева Р., Мурзакаримова Л. Эрманбетов А., Максутова Э., Болоцких И., Мамбетаипова Ч. И др. Программа пятилетнего плана по постепенному увеличению государственного финансирования для обеспечения потребностей 50% женщин из групп высокого медицинского и социального рисков материнской смертности до 2023 года. Бишкек; 2022. 54 с. Режим доступа: https://kyrgyzstan.unfpa.org/sites/default/files/pub-pdf/5_year_plan_-_rus_0.pdf
6. Дикке Г.Б. Медикаментозный аборт в амбулаторной практике. М.: ГЭОТАР-Медиа; 2018. 384 с.
7. Всемирная организация здравоохранения. Руководство по уходу при прерывании беременности: основные положения. Женева: ВОЗ; 2022. 19 с. Режим доступа: https://iris.who.int/rest/bitstreams/1416761/retrieve
8. Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLоS ONE. 2016;11(2): e0148343. https://doi.org/10.1371/journal. pone.0148343
9. World Health Organization. WHO statement on cesarean delivery. April 2015. Available from: http://www.who.int/reproductivehealth/publicati ons/maternal_ perinatal_health/csstatement/en/
10. Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. The Lancet. 2018;382(10155):1341-1348. https://doi.org/10.1016/S0140-6736(18)31928-7
11. Национальный статистический комитет Кыргызской Республики. Женщины и мужчины Кыргызской Республики: 2016–2020. Бишкек; 2021. 307 с. Режим доступа: http://www.stat.kg/media/publicationarchive/b057b115-c40b-4180-ae16-28ec7e459117.pdf
12. Туруктуу өнүгүү максаттары. Жеткиликтүү: https://kyrgyzstan.un.org/ky/sdgs
13. Жолдошбекова Г.Ж., Стакеева Ч.А., Амираева Ж.Н., Тогузбаева Б.Д., Айтбек к. Д., Сыдыкова А.К. Родоразрешение беременных с антенатальной гибелью плода при наличии рубца на матке после операции кесарево сечения. Вестник КГМА им. И.К. Ахунбаева. 2023;2:135-143. https://doi.org/10.54890/1694-6405_2023_2_135
14. International Federation of Gynecology and Obstetrics. FIGO Mifepristone & Misoprostol and Misoprostol Only Dosing Charts 2023. Available from: https://www.figo.org/figo-mifepristone-misoprostol-and-misoprostol-only-dosing-charts-2023/
15. Newcombe RG. Two-sided confidence intervals for the single proportion: Comparison of seven methods. Statistics in Medicine. 1998;17:857-872. https://doi.org/10.1002/(sici)1097-0258(19980430)17:8<857::aid-sim777>3.0.co;2-e
16. Пустотина О.А. Прегравидарная подготовка. Медицинский совет. 2017;13:64-70.
17. Планирование семьи: универсальное руководство для поставщиков услуг по планированию семьи. Обновленное 3-е издание 2018 г. Копенгаген: Европейское региональное бюро ВОЗ; 2021. 562 с. Режим доступа: https://www.who.int/ru/publications/i/item/9780999203705
18. Пренаталдык даярдык боюнча клиникалык колдонмолор (биринчи медициналык жардам көрсөтүү үчүн). Бишкек; 2022. 89 б. Жеткиликтүү: https://med.kg/clinicalProtocols?locale=ru
19. Morris JL, Winikoff B, Dabash R, Weeks A, Faundes A, Gemzell-Danielsson K, at al. FIGO’s updated recommendations for misoprostol used alone in gynecology and obstetrics. Int J Gynecol Obstet. 2017;138(3):363–366. https://doi.org/ 10.1002/ijgo.12181
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