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Am J Obstet Gynecol. 1994 Aug;171(2):554-7.

Safety of midtrimester pregnancy termination by laminaria and evacuation in patients with previous cesarean section.

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  • 1Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.



The objective of this study was to retrospectively assess whether there was an increased perioperative risk in midtrimester pregnancy termination by laminaria and evacuation associated with a previous uterine scar.


From 1978 to 1993 1064 patients underwent midtrimester (14 to 22 weeks) pregnancy termination by means of laminaria and evacuation. Of these, 70 patients had a previous uterine scar and are the subjects of this study.


There were no major operative complications, such as anesthetic complications, perforations, or cervical lacerations, in the entire series. Mean operative time (minutes) for induced abortion was statistically similar in the unscarred compared with the scarred uteri groups (8.03 +/- 4.40 vs 7.46 +/- 4.42, respectively) and was statistically different when the indication for evacuation was missed abortion (6.08 +/- 1.86 vs 4.81 +/- 2.11, respectively; p < 0.005). This difference in operative time could be explained by the number of laminaria tents used in each group. Atony with hemorrhage occurred in two patients who underwent induced abortion, and disseminated intravascular coagulation occurred in eight missed abortion cases, but none had scarred uterus.


Previous cesarean section scar does not seem to increase the perioperative risk of late termination (14 to 22 weeks) by the laminaria and evacuation technique.


Obstetrician-gynecologists at Assaf Harofeh Medical Center in Zerifin, Israel, performed 1064 midtrimester (14-22 weeks) pregnancy terminations between 1978 and 1993 by the laminaria and evacuation technique. Medical researchers wanted to determine whether the 70 (6.6%) patients with a previous Cesarean section faced an increased perioperative risk. None of the 70 women suffered any major complications (e.g., cervical lacerations). The mean operative time for women with a scarred uterus was not significantly different than that for those with an unscarred uterus (7.44 vs. 8 minutes). When the researchers examined only missed abortion cases, however, the mean operative time for women with a scarred uterus was significantly shorter than that for women with an unscarred uterus (4.8 vs. 6 minutes; p .005). Among missed abortion cases, more laminaria tents were needed in women with a scarred uterus than in those with an unscarred uterus (3.7 vs. 2.91; p .01), suggesting that the number of laminaria tents accounted for the difference in operative time. Among women with an unscarred uterus, 8 missed abortion cases had disseminated intravascular coagulation and 2 women experienced uterine atony with hemorrhage during the induced abortion. Except for those with disseminated intravascular coagulation, all the women were discharged from the hospital on the same day as the procedure. These findings show that laminaria and evacuation is a safe midtrimester pregnancy termination technique and that, since it requires only a few hours in an outpatient postoperative facility, it is also cost effective.

[PubMed - indexed for MEDLINE]
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