Original research article| Volume 85, ISSUE 6, P589-594, June 2012

Second- and third-trimester termination of pregnancy in women with uterine scar ��� a retrospective analysis of 111 gemeprost-induced terminations of pregnancy after previous cesarean delivery



      This study was conducted to evaluate and analyze the efficacy and safety of using gemeprost for second- and third-trimester termination of pregnancy (TOP) in women with uterine scar due to previous cesarean section.

      Study Design

      Retrospective analysis of 111 medical TOPs for fetal anomaly or death at 14 to 34 weeks of gestation in women with a history of cesarean section was performed at a German tertiary care center from 2005 to 2009. Abortion was induced via intravaginal application of the prostaglandin analogue gemeprost (1 mg) every 6 h.


      One hundred eleven women with one (89.2%) or two (10.8%) previous cesarean sections underwent medical TOP with gemeprost. The median induction-to-expulsion interval was 18 h 24 min (range, 2 h 20 min���168 h 28 min), and in 34 (30.6%) cases, the induction interval was longer than 24 h. The overall incidence of severe complications was 9/111 (8.1%), including one case of silent uterine rupture (with the need for blood transfusion), four cases of atonic and three secondary hemorrhages and one case of peritonitis due to uterine perforation during curettage. Failure of induction (induction-to-expulsion >48 h) occurred in 11 cases (9.9%).


      Gemeprost-induced TOP in the second and third trimester in women with uterine scar due to previous cesarean section is effective and has a low complication rate.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Chapman S.J.
        • Crispens M.
        • Owen J.
        • Savage K.
        Complications of midtrimester pregnancy termination: the effect of prior cesarean delivery.
        Am J Obstet Gynecol. 1996; 175: 889-892
        • Scioscia M.
        • Pontrelli G.
        • Vimercati A.
        • Santamato S.
        • Selvaggi L.
        A short-scheme protocol of gemeprost for midtrimester termination of pregnancy with uterine scar.
        Contraception. 2005; 71: 193-196
        • Lalitkumar S.
        • Bygdeman M.
        • Gemzell-Danielsson K.
        Mid-trimester induced abortion: a review.
        Hum Reprod Update. 2007; 13: 37-52
        • Ngai S.W.
        • Tang O.S.
        • Ho P.C.
        Prostaglandins for induction of second-trimester termination and intrauterine death.
        Best Pract Res Clin Obstet Gynaecol. 2003; 17: 765-775
        • Goyal V.
        Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review.
        Obstet Gynecol. 2009; 113: 1117-1123
        • Miller D.A.
        • Diaz F.G.
        • Paul R.H.
        Vaginal birth after cesarean: a 10-year experience.
        Obstet Gynecol. 1994; 84: 255-258
        • Gao P.
        • Wang P.
        Clinical observation on termination of early pregnancy of 213 cases after caesarian section with repeated use of mifepristone and misoprostol.
        Reprod Contracept. 1999; 10: 227-233
        • Rosen M.G.
        • Dickinson J.C.
        • Westhoff C.L.
        Vaginal birth after cesarean: a meta-analysis of morbidity and mortality.
        Obstet Gynecol. 1991; 77: 465-470
        • Lydon-Rochelle M.
        • Holt V.L.
        • Easterling T.R.
        • Martin D.P.
        Risk of uterine rupture during labor among women with a prior cesarean delivery.
        N Engl J Med. 2001; 345: 3-8
        • Gautam R.
        • Agrawal V.
        Early medical termination pregnancy with methotrexate and misoprostol in lower segment cesarean section cases.
        J Obstet Gynaecol Res. 2003; 29: 251-256
        • Thong K.J.
        • Baird D.T.
        An open study comparing two regimens of gemeprost for the termination of pregnancy in the second trimester.
        Acta Obstet Gynecol Scand. 1992; 71: 191-196
        • Boulot P.
        • Hoffet M.
        • Bachelard B.
        • et al.
        Late vaginal induced abortion after a previous cesarean birth: potential for uterine rupture.
        Gynecol Obstet Invest. 1993; 36: 87-90
        • Daskalakis G.J.
        • Mesogitis S.A.
        • Papantoniou N.E.
        • Moulopoulos G.G.
        • Papapanagiotou A.A.
        • Antsaklis A.J.
        Misoprostol for second trimester pregnancy termination in women with prior caesarean section.
        BJOG. 2005; 112: 97-99
        • Wong K.S.
        • Ngai C.S.
        • Wong A.Y.
        • Tang L.C.
        • Ho P.C.
        Vaginal misoprostol compared with vaginal gemeprost in termination of second trimester pregnancy. A randomized trial.
        Contraception. 1998; 58: 207-210
        • Wong K.S.
        • Ngai C.S.
        • Yeo E.L.
        • Tang L.C.
        • Ho P.C.
        A comparison of two regimens of intravaginal misoprostol for termination of second trimester pregnancy: a randomized comparative trial.
        Hum Reprod. 2000; 15: 709-712
        • Berghella V.
        • Airoldi J.
        • O'Neill A.M.
        • Einhorn K.
        • Hoffman M.
        Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review.
        BJOG. 2009; 116: 1151-1157
        • Dodd J.M.
        • Crowther C.A.
        Misoprostol for induction of labour to terminate pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death.
        Cochrane Database Syst Rev. 2010; : CD004901
        • Wildschut H.
        • Both M.I.
        • Medema S.
        • Thomee E.
        • Wildhagen M.F.
        • Kapp N.
        Medical methods for mid-trimester termination of pregnancy.
        Cochrane Database Syst Rev. 2011; : CD005216
        • Landon M.B.
        • Hauth J.C.
        • Leveno K.J.
        • et al.
        Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery.
        N Engl J Med. 2004; 351: 2581-2589
        • Scioscia M.
        • Vimercati A.
        • Pontrelli G.
        • Nappi L.
        • Selvaggi L.
        Patients' obstetric history in mid-trimester termination of pregnancy with gemeprost: does it really matter?.
        Eur J Obstet Gynecol Reprod Biol. 2007; 130: 42-45
        • Wagner N.
        • Abele H.
        • Hoopmann M.
        • et al.
        Factors influencing the duration of late first and second-trimester termination of pregnancy with prostaglandin derivates.
        Eur J Obstet Gynecol Reprod Biol. 2011; 155: 75-78
        • Marinoni E.
        • Santoro M.
        • Vitagliano M.P.
        • Patella A.
        • Cosmi E.V.
        • Di Iorio R.
        Intravaginal gemeprost and second-trimester pregnancy termination in the scarred uterus.
        Int J Gynaecol Obstet. 2007; 97: 35-39
        • le Roux P.A.
        • Pahal G.S.
        • Hoffman L.
        • Nooh R.
        • El-Refaey H.
        • Rodeck C.H.
        Second trimester termination of pregnancy for fetal anomaly or death: comparing mifepristone/misoprostol to gemeprost.
        Eur J Obstet Gynecol Reprod Biol. 2001; 95: 52-54
        • Nor Azlin M.I.
        • Abdullah H.S.
        • Zainul Rashid M.R.
        • Jamil M.A.
        Misoprostol (alone) in second trimester terminations of pregnancy: as effective as Gemeprost?.
        J Obstet Gynaecol. 2006; 26: 546-549
        • Wing D.A.
        • Lovett K.
        • Paul R.H.
        Disruption of prior uterine incision following misoprostol for labor induction in women with previous cesarean delivery.
        Obstet Gynecol. 1998; 91: 828-830
        • Aslan H.
        • Unlu E.
        • Agar M.
        • Ceylan Y.
        Uterine rupture associated with misoprostol labor induction in women with previous cesarean delivery.
        Eur J Obstet Gynecol Reprod Biol. 2004; 113: 45-48
        • Plaut M.M.
        • Schwartz M.L.
        • Lubarsky S.L.
        Uterine rupture associated with the use of misoprostol in the gravid patient with a previous cesarean section.
        Am J Obstet Gynecol. 1999; 180: 1535-1542
        • Dickinson J.E.
        • Doherty D.A.
        Factors influencing the duration of pregnancy termination with vaginal misoprostol for fetal abnormality.
        Prenat Diagn. 2009; 29: 520-524
        • Prager S.W.
        • Oyer D.J.
        Second-trimester surgical abortion.
        Clin Obstet Gynecol. 2009; 52: 179-187