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

OBJECTIVE: 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. STUDY DESIGN: 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. RESULTS: 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. CONCLUSION: 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.