Termination of Pregnancy in Previous Scarred Uterus: PGE1 Versus Cervical Folleys

Overview

As mentioned above, previous studies have shown variable results and the best among these two is still in debate, so there must be re-evaluation of results on this topic. The rationale of this study is to compare the efficacy (in terms of complete evacuation) of PGE1 versus cervical folleys in termination of pregnancy. This study not only will lead to the decision regarding selection of appropriate method with less comorbidities but also add in the literature regarding the women health improvement that is a matter of concern in 21st century. Then based on the results of my study, these particular patients can be provided with better way of second trimester termination of pregnancy in order to reduce the complications of the incomplete miscarriage as well as morbidity and mortality of these patients

Among unintended 205 million pregnancies that occur each year worldwide, about 20% of them end in induced abortion. Majority of these abortions occur during the first trimester of pregnancy. The second trimester of pregnancy is subdivided into an early period between 13-20 weeks and a late period between 20-28 weeks. Advanced screening techniques have led to an increase in the detection of congenital malformations with subsequent gradual increase in second trimester termination of pregnancy which represents 10-15% of total abortions performed worldwide. Termination in the second trimester is more risky than during first trimester. So the pharmacologic management seems to be an appealing alternative to surgical evacuation. There is a wide range of prostaglandin preparations available which can be used for cervical ripening or induction of labour. Misoprostol is a synthetic prostaglandin E1 analogue. It was first used in obstetrics to induce abortion in 1988. Now it is widely used for induction of labour, termination of pregnancy and management of postpartum haemorrhage but still its use in obstetrics is not approved by FDA. Mechanical dilatation of cervix to induce abortion or labour is also known since 1833. The Foleys catheter traction is the cheapest, safest and successful mechanical method of cervical dilatation according to various studies. The decision regarding the effectiveness of any of the above two modality in women with previous cesarean is still a debate