Induced Abortion After Previous Caesarean Section: A Scoping Review.

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.