既往剖宫产术后人工流产:范围回顾。

IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Natalie Drever, Vinay Gangathimmaiah, Brittany van Der Lugt, Cecelia O'Brien, Catriona Melville, Kirsten Black, Caroline de Costa
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引用次数: 0

摘要

背景:既往剖宫产(CS)在人工流产妇女中越来越普遍。目的:对既往CS患者的流产安全性、结局和处理进行文献梳理和分析。材料与方法:系统检索自成立至2024年7月的4个数据库。纳入了先前CS妇女妊娠早期或中期药物流产(MToP)或手术流产(SToP)的结局、安全性或管理的英文初步人类研究。通过CS的数量和前列腺素的使用类型,对妊娠早期和中期子宫破裂的发生率进行累积分析。收集MToP和SToP的有效性和安全性数据,包括关于异常胎盘情况下流产管理的研究报告,并按主题进行分析。结果:164篇文章符合纳入标准。妊娠早期MToP的发生率为0/ 2194例,妊娠中期米索前列醇MToP的发生率为0.5%(10/1910)和2.2%(18/835),既往CS≥2例的妇女(p结论:既往CS妇女在妊娠早期和中期进行药物和手术流产是安全的;然而,风险包括子宫破裂,需要手术干预和未确诊的胎盘增生出血。既往经典宫内妊娠、既往宫内妊娠≥3次及胎盘异常侵入性流产的处理需要进一步的研究和指导。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Induced Abortion After Previous Caesarean Section: A Scoping Review.

Background: Previous caesarean section (CS) is increasingly common among women undergoing induced abortion.

Aims: To map and analyse existing literature on abortion safety, outcomes and management in those with previous CS.

Materials and methods: Four databases were systematically searched from inception to July 2024. Primary human studies in English reporting on outcomes, safety or management of first- or second-trimester medical (MToP) or surgical (SToP) abortion in women with previous CS were included. Uterine rupture incidence was analysed cumulatively in the first and secondtrimesters by the number of CS and the type of prostaglandin used. Data on the efficacy and safety of MToP and SToP, including studies reporting on the management of abortion in the setting of abnormal placentation, were collected and analysed by theme.

Results: In total, 164 articles met inclusion criteria. Incidence of uterine rupture in first-trimester MToP was 0 of 2194 cases, in second-trimester misoprostol MToP in those with 1 previous CS was 0.5% (10/1910) and 2.2% (18/835) in women with ≥ 2 CS (p < 0.001). Mifepristone priming did not increase the rupture rate in second-trimester MToP (p = 0.77). Previous CS was a modest risk factor for retained products after MToP across both trimesters (OR 1.48, CI 1.29-1.70).

Conclusion: Medical and surgical abortion in the first and second trimester appears safe in women with prior CS; however, risks include uterine rupture, need for surgical intervention and haemorrhage from undiagnosed placenta accreta. Further research and guidance are needed on managing abortion after previous classical CS, ≥ 3 previous CS and those with abnormally invasive placenta.

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来源期刊
CiteScore
3.40
自引率
11.80%
发文量
165
审稿时长
4-8 weeks
期刊介绍: The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.
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