Second- and third-trimester therapeutic terminations of pregnancy in cases with complete placenta previa - Does feticide decrease postdelivery maternal hemorrhage?

R. Ruano, Y. Dumez, D. Cabrol, M. Dommergues

Research output: Contribution to journalReview article

26 Scopus citations

Abstract

Objective: To study the feasibility of second- and thirdtrimester termination of pregnancy (TOP) with complete placenta previa, and the impact of performing feticide before labor induction on maternal hemorrhagic morbidity. Patients and Methods: From 1987 to 2002, the databases of two referral hospitals were reviewed. We identified 15 cases of second- or third-trimester TOP in women with complete placenta previa. Feticide was performed 2-14 days before induction in 6/15 cases. Cervical ripening was achieved in 8 cases by mifepristone alone (n = 2) or by mifepristone and dilapan (n = 6). Labor was induced by vaginal gemeprost (n = 2), intramuscular (n = 5) or intravenous (n = 4) sulprostone, vaginal misoprostol (n = 1) or a combination of misoprostol and sulprostone (n = 3). Hemorrhage was defined by the need for transfusion. The difference between the preoperative and the lowest per- or postoperative maternal hemoglobin level was also analyzed. Results: Of the 9 women who underwent labor induction without previous feticide, 4 required blood transfusions, 1 of whom had a hemostat hysterectomy. The mean hemoglobin difference was 2.5 g/dl (range: 0.5-5.3). None of the 6 patients with preinduction feticide required transfusion. The hemoglobin difference was significantly smaller in this group than in terminations without previous feticide (mean: 1.0 g/dl ; range: 0.1-2.2; p = 0.03). Conclusion: In cases with complete placenta previa, second- or third-trimester TOP is feasible. It carries a substantial risk of hemorrhage that might be decreased by preinduction feticide.

Original languageEnglish (US)
Pages (from-to)475-478
Number of pages4
JournalFetal Diagnosis and Therapy
Volume19
Issue number6
DOIs
StatePublished - Nov 22 2004

Keywords

  • Dilapan
  • Feticide
  • Hemorrhage
  • Mifepristone
  • Misoprostol
  • Placenta previa
  • Termination of pregnancy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Embryology
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

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