Number of prior caesarean deliveries tied to complication risk following second-trimester abortion

While induction in the second trimester for abortion or foetal demise can be safely performed for most women with prior caesarean deliveries, the risk of complications is increased for women with two or more prior caesarean deliveries, a study has found.

The study included 520 patients who underwent induction for abortion or foetal demise for pregnancies from 14 weeks to 23 weeks of gestation. None of the patients had preterm labour or cervical insufficiency and neonatal interventions. Misoprostol was the primary induction method used.

Researchers compared complication rates between patients with no prior, one prior, and two or more (2+) prior caesarean deliveries. Complications included retained placenta, failed induction, infection, haemorrhage, blood transfusion, uterine rupture, intensive care unit (ICU) admission, death, and readmission.

Of the patients, 411 had no prior caesarean delivery, 77 had one, and 32 had two or more. There were 11 patients who had a prior vertical uterine incision, and 26.5 percent of the population received mifepristone.

Patients who had prior caesarean delivery overall were more likely to be obese (p=0.003). Compared with those who had none or one prior, patients with 2+ prior caesarean delivery were older (p<0.001) and more likely to be induced for foetal demise (p=0.04), experience uterine rupture (p=0.004), and require ICU admission (p=0.02). Misoprostol dosages and rates of complete abortion were similar across the groups.

Logistic regression analysis showed having 2+ prior caesarean deliveries was associated with greater odds of experiencing a complication compared with 1 prior (adjusted odds ratio [aOR], 2.71, 95 percent confidence interval [CI], 1.09–6.86; p=0.03) or no prior caesarean delivery (aOR, 3.00, 95 percent CI, 1.30–7.02; p=0.01).

On the other hand, patients with 1 prior or no prior caesarean deliveries had a similar likelihood of experiencing a complication (aOR, 1.11, 95 percent CI, 0.64–1.89; p=0.7).