Second Trimester Pregnancy Termination in Previous Cesarean Section Patients With Unfavorable Cervix: A Randomized Controlled Clinical Trial Comparing 3 Different Methods

Abstract

Introduction Induction of labor (IOL) in previous cesarean section (SC) patients with unripe cervix represents a major challenge for obstetricians to avoid fetal and maternal complications which may be catastrophic. Termination of pregnancy (TOP) in sec-ond trimester by IOL is usually performed when complications occur, such as severe preeclampsia and ruptured membranes. The other common medical indications include uncontrolled hypertension, impaired renal functions, and malignancy any-where requiring immediate management [1]. Women with previous CS had an increased risk of uterine rupture than patients with unscarred uterus, so IOL in these patients should be done after thorough and detailed counseling with both patient and their relatives [2]. Many studies evaluated different methods of labor induc-tion when the cervix is unfavorable, including misoprostol, transcervical insertion of Foley's catheter, double-balloon cath-eter, laminaria tents, and oxytocin intravenous drip. These methods were classified roughly into either pharmacological or mechanical methods [3,4]. Although misoprostol (PGE1) is widely used for labor induction, it has a high incidence of uterine hyperstimulation and subsequent rupture uterus which is a nightmare for mis-oprostol users, especially in women with CS, so misoprostol is not recommended in those patients.5,6 On the contrary, vaginal dinoprostone is safer and had less uterine hyperstimulation and less fetal distress, but is less effective than misoprostol and somewhat expensive [7]. Foley's catheter is another procedure used for mechanical IOL, which involves transcervical insertion of Foley's catheter. Foley's catheter induces labor by both mechanical dilatation and stimulating endogenous release of prostaglandins [8,9]. Another new method for labor induction was tested at a low scale of populations, which is the intracervical injection of hyaluronidase. Hyaluronidase is an enzyme that increases hydrolysis of hyaluronic acid, decreases the tensile strength of cervical collagen, and hence promotes cervical softening and effacement [10]. Mechanical methods apply pressure on the internal cervical os, stretch the lower uterine segment, and increase local pro-Volume 3 Issue 4 -2017 Abstract Background: Vaginal termination of second trimester pregnancy is usually performed when complications occur. In this study, we com-pared 3 methods of vaginal termination regarding time to effacement and delivery in addition to delivery success rate.