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Second-trimester abortion care for those with complex medical conditions
Andrea Henkel1, Paul D Blumenthal
1Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California, USA.
Current Opinion in Obstetrics & Gynecology
|August 29, 2022
Summary
Second trimester abortions carry risks, especially for those with prior cesarean births. Careful planning and preparedness can significantly mitigate potential complications during abortion care.
Area of Science:
- Reproductive Health
- Maternal-Fetal Medicine
Background:
- Second trimester abortions can be complex for patients with certain medical histories.
- Prior cesarean birth is a significant risk factor for hemorrhage and uterine perforation during second trimester abortion.
Approach:
- Reviewing risk factors and mitigation strategies for second trimester abortion.
- Evaluating predictive ultrasound findings for placenta accreta spectrum (PAS).
- Assessing medication interactions and alternatives for cervical preparation.
Key Points:
- Multiple prior cesarean births increase risks of hemorrhage and uterine perforation.
- Specific ultrasound findings in early pregnancy may predict PAS.
- Ulipristal may serve as an adjunct for cervical preparation, avoiding mifepristone interactions.
- Patients with severe early-onset hypertensive disorders require careful platelet monitoring and potential transfusion.
Conclusions:
- Preprocedural planning and intra-operative preparedness are crucial for mitigating risks in second trimester abortion.
- Identifying high-risk patients and implementing targeted strategies can improve safety outcomes.
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