Modern approach to pregnancy termination in the second trimester in patients with uterine scar and congenital fetal malformations

Tishkova O.G.; Dikareva L.V.; Vlasova N.A.

doi:https://doi.org/10.17116/rosakush20212102156

Tishkova O.G.

Astrakhan State Medical University

ORCID: 0000-0002-1894-5809

Dikareva L.V.

Astrakhan State Medical University

ORCID: 0000-0001-9179-1669

Vlasova N.A.

Astrakhan State Medical University

Modern approach to pregnancy termination in the second trimester in patients with uterine scar and congenital fetal malformations

Authors:

Tishkova O.G., Dikareva L.V., Vlasova N.A.

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Journal: Russian Bulletin of Obstetrician-Gynecologist. 2021;21(2): 56‑61

DOI: 10.17116/rosakush20212102156

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To cite this article:

Tishkova OG, Dikareva LV, Vlasova NA. Modern approach to pregnancy termination in the second trimester in patients with uterine scar and congenital fetal malformations. Russian Bulletin of Obstetrician-Gynecologist. 2021;21(2):56‑61. (In Russ.)
https://doi.org/10.17116/rosakush20212102156

Подписка 2026 Российский вестник акушера-гинеколога (Russian Bulletin of Obstetrician-Gynecologist)

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OBJECTIVE

Assessment the efficacy and safety of medical abortion in patients with a scar on the uterus and fetus’ congenital malformations incompatible with life in the second trimester of pregnancy.

MATERIAL AND METHODS

In a retrospective analysis for the period 2015—2018 118 of patients’ cards with congenital fetal malformations were included. The prospective study group consisted of 21 patients with a scar on the uterus and congenital malformations of the fetus in gestational terms from 18 to 21 weeks whose pregnancy was terminated by medical abortion. The comparison group included 18 patients with a scar on the uterus and congenital malformations of the fetus in whom according to the totality of indications the pregnancy was terminated by a small cesarean section.

RESULTS

During the study period, a 20% increase in the number of observations of congenital anomalies of fetal development in the periods from 18 to 21 weeks of gestation was noted. Among congenital malformations of the fetus, 42% were concomitant defects, 34% were CNS defects, 24% were cardiovascular anomalies. In 100% of cases, medical abortion turned out to be an effective method of terminating pregnancy in patients with a scar on the uterus at the specified time. Complications such as hematologohiometer (27.8%), bleeding (11.1%), and endometritis (16.7%) were significantly more frequent in patients after pregnancy termination with the help of a small cesarean section. Based on the data obtained, it was established that medical abortion in the second trimester of gestation in women with a scar on the uterus and congenital fetal malformations that are incompatible with life is the safest, minimally invasive method of abortion with a favorable course of the post-abortion period. The use of this method of termination of pregnancy made it possible to shorten the recovery period, as well as the duration of hospital stay by almost 2 times.

CONCLUSION

Medical abortion in patients with a scar on the uterus and congenital malformations of the fetus, incompatible with life is the choice method in the second trimester of pregnancy and should be performed in all cases in the absence of contraindications. With such type of pregnancy termination a significant economic effect is determined associated with the absence of additional financial costs not only for the operation, treatment of early complications, but also for overcoming the further consequences of surgical delivery (endometritis, inconsistency of the uterine scar, rotation of the placenta, infertility). This approach will reduce the number of unnecessary caesarean sections and the complications associated with them which will undoubtedly improve the reproductive women health.

Keywords:

congenital malformations of the fetus

medical abortion

minor cesarean section

II trimester of pregnancy

patients with uterine scar

Authors:

Tishkova O.G.

Astrakhan State Medical University

ORCID: 0000-0002-1894-5809

Dikareva L.V.

Astrakhan State Medical University

ORCID: 0000-0001-9179-1669

Vlasova N.A.

Astrakhan State Medical University

Received:

28.08.2020

Accepted:

24.11.2020

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