Second-trimester pregnancy termination in patients with plac
Pregnancy termination during the second trimester in patients with placenta previa and placenta accreta spectrum (PAS) is a complex and challenging clinical problem.

In the present study, a retrospective analysis was conducted to compare the clinical outcomes when different management strategies were used to terminate pregnancy in the patients with placenta previa and PAS.

A total of 51 patients who underwent pregnancy termination were retrospectively analyzed in this study. All patients having previous cesarean delivery (CD) were diagnosed with placenta previa status and PAS.

- Among the 51 patients, 16 cases received mifepristone and misoprostol medical termination, 15 cases received mifepristone and Rivanol medical termination, but 1 of them was transferred to hysterotomy due to failed labor induction, another 20 cases were performed planned hysterotomy. There were no placenta percreta cases and uterine artery embolization (UAE) was all performed before surgery.

- There were 31 cases that underwent medical termination and 30 cases were vaginal delivery. Dilation and evacuation (D&E) were used in 20 cases of medical abortion failure and in all 30 cases of difficult manual removal of placental tissue.

- A statistically significant difference was found among the three different strategies in terms of gestational weeks, the type of placenta previa status, main operative success rate, and ?-HCG regression time.

- There were 4 cases who were taken up for hysterectomy because of life-threatening bleeding or severe bacteremia during or after delivery and hysterotomy. The uterus was preserved with the implanted placenta partly or completely left in situ in 47 cases. Combined medical and/or surgical management were used for the residual placenta and the time of menstrual recovery was 52 days after pregnancy termination.

Terminating a pregnancy by vaginal delivery through medical induction of labor may be feasible if clinicians have an overall understanding of gestational age, the type of placenta previa status, the type of placenta accreta, and patients' concerns about preserving fertility.

BMC Pregnancy and Childbirth
Source: https://doi.org/10.1186/s12884-021-04017-8
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