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The ability of a drug to produce structural deformations and functional abnormalities in the developing embryo or the fetus is called teratogenicity, and the drug producing this effect is known as a teratogen. Teratogenic effects include stillbirth, miscarriage, intrauterine growth restriction, and neurocognitive delay. A teratogen may affect the embryo at different stages of development, which is important in determining the type and extent of the damage. During blastocyst formation, the early...
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Induced Abortion After Previous Caesarean Section: A Scoping Review.

Natalie Drever1,2, Vinay Gangathimmaiah3,4, Brittany van Der Lugt2

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Induced abortion is generally safe for women with a previous caesarean section (CS). While uterine rupture is rare, risks like retained products and hemorrhage require careful management, especially after multiple CS.

Keywords:
abortionaccretacaesarean sectionreviewtermination of pregnancy

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Area of Science:

  • Reproductive Health
  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine

Background:

  • Previous caesarean section (CS) is a growing factor in women seeking induced abortion.
  • Understanding abortion outcomes in this population is crucial for clinical practice.

Purpose of the Study:

  • To systematically review and analyze the existing literature on abortion safety, outcomes, and management in women with a history of CS.
  • To provide an evidence-based overview for clinicians managing these cases.

Main Methods:

  • Systematic search of four databases (inception to July 2024) for English-language primary human studies.
  • Inclusion of studies on first- or second-trimester medical (MToP) or surgical (SToP) abortion in women with prior CS.
  • Cumulative analysis of uterine rupture incidence by number of CS and prostaglandin type; thematic analysis of efficacy, safety, and management, including abnormal placentation.

Main Results:

  • Uterine rupture incidence in first-trimester MToP was 0%; in second-trimester MToP with one prior CS, it was 0.5%, and with ≥2 CS, it was 2.2% (p < 0.001).
  • Mifepristone priming did not significantly alter second-trimester MToP rupture rates (p=0.77).
  • Previous CS was a modest risk factor for retained products after MToP (OR 1.48, CI 1.29-1.70).

Conclusions:

  • Medical and surgical abortion in the first and second trimesters are generally safe for women with prior CS.
  • Key risks include uterine rupture, need for surgical intervention, and hemorrhage, particularly with undiagnosed placenta accreta.
  • Further research is needed for managing abortion after classical CS, ≥3 CS, and abnormally invasive placenta.