الفهرس 
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Abstract
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UMMARY
econd trimester, mid trimester pregnancy, is defined as a period of gestation between 13 to 28 weeks and commonly subdivided into early ranging from 13 to 20 weeks and late from 20 to 28 weeks. Termination of pregnancy by induced abortion is one of the commonest procedures. Mid trimesteric abortion constitutes 10-15% of all cases of induced abortion.
Surgical and medical methods of the second trimesteric abortion have both evolved in the past 30 years. Dilation and evacuation procedure (D&E) introduced in 1970s has become the preferred surgical technique over D&C, hystrotomy and hystrectomy because of its relative safety.
Medical methods for induced abortion have emerged over the past two decades as a safe effective alternative to surgery. Uterine evacuation by the medical methods reduces the morbidity associated with surgical intervention.
Synthetic prostaglandin has largely replaced all other techniques for termination particularly in the second trimester because prostaglandins play an important role in regulation of uterine contractility. Pregnancy termination in case with prior cesarean delivery becomes an increasingly common situation facing obstetricians due to progressive increase in the rate and incidence of cesearean births.
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Medical termination of the second trimesteric pregnancy, mainly by Misoprostol (prostaglandins E1) use, offers a high possibility for improving access and relative safety owing to its simplicity in compare to surgical techniques but might be complicated by uterine hyperstimulation and subsequent uterine rupture especially in women with previous scars.
The use of intracervical extra-amniotic foleys’s catheter is another procedure used for mechanical cervical ripening and stimulating endogenous release of prostaglandins and cytokines that make the cervix inducible and eases the process of termination.
Some stated that the combination of intracervical foley’s catheter with Misoprostol simultaneously gave shorter induction-to-abortion intervals. Concern persists that a trial of labor in women with previous uterine scar may increase the risk of maternal complications as compared with elective cesarean delivery, such complications include uterine rupture, which is uncommon but serious and that may result in hysterectomy, urologic injury, a need for blood transfusion, maternal death.
Uterine rupture is a rare complication of pregnancy leading to sever fetal and maternal morbidity and mortality, sevral risk factors have been identified, the most important are a uterine scar and the use of uterotonic agents.
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The main aim of this study was to assess and evaluate the outcomes of second trimester induction of abortion in previously scarred uterus.
This retrospective study was conducted at Ain Shams Maternity Hospital at the period from the 1st of January 2018 till the 31st of December 2020.
The main results of the study revealed that:
The study included 200 patients with mean ±SD age of 30.4 ± 5.9 years (range 18 to 43 years). Mean ± SD gestational age was 17.7 ± 3.4 weeks (range, 14 to 26 weeks).
One-hundred and sixty-nine (84.5%) patients underwent successful medical abortion while 31 patients (15.5%) suffered failed medical abortion.
Failed medical abortion group have significantly higher incidence of adverse events including hemorrhage need of blood transfusion, need of D & E, hysterotomy and uterine rupture.
Increased gestational age (odds ratio = 0.837, 95% CI = 0.733 to 0.956, p = 0.009), history of 3 or more CS (odds ratio = 0.234, 95% CI = 0.086 to 0.634, p = 0.004), and presence of >1 gestational sac (odds ratio = 0.094, 95% CI = 0.011 to 0.776, p = 0.028) are independently associated with decreased probability of successful medical abortion. Higher total dose of misoprostol (odds ratio = 0.9997, 95% CI =
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0.9994 to 1.0000, p = 0.051) is only marginally associated with decreased probability of success. On the other hand, higher hemoglobin level (odds ratio = 1.652, 95% CI = 1.198 to 2.279, p =.002) is independent predictor of successful medical abortion.
Patients subjected to hysterotomy received significantly higher dosed of misoprostol compared with those who did not undergo hysterotomy (median [IQR] = 1100 [800 – 2400] mg versus 800 [500 – 1600] mg, respectively; p =.047).
Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.