Effect of fetal diagnosis on the outcomes of second-trimester pregnancy termination for fetal abnormalities: A pilot study

[Factors Associated with Prolonged Duration of Labor in Medical Termination of Pregnancy in the 2nd and 3rd Trimesters]

OBJECTIVE

In the context of a medical termination of pregnancy, prolonged labor may accentuate the difficulty of women's experience and increase the risk of associated complications. The factors associated with prolonged labor are not known. Reducing the duration of labor could limit these complications. Determining the relevant factors associated with prolonged labor defined as a delay between the onset of induction and delivery greater than or equal to 12hours and comparing the complications rates between the two groups.

METHOD

We conducted a retrospective study at Port Royal Maternity Hospital from 2017 to 2019, including medical terminations of pregnancy by vaginal delivery in the 2nd and 3rd trimesters for fetal or maternal reasons.

RESULTS

Two hundred twenty-seven patients were included and divided into two comparative groups based on the duration of labor: labor <12h (n=173) and labor ≥12h (n=54). The mean maternal age was 33.7 years. Forty-four percent of patients were nulliparous, 15.8 % had a history of cesarean section. The average gestational age was 20+2 weeks of gestation. The average duration of labor was 9.7hours. The duration of labor was greater than 24hours in 3% of cases (7/227). Advanced gestational age (22+3 vs. 20+5 p=0,04) and nulliparity (p=0.01) were associated with prolonged labor. Two other intermediate factors, not independent of the duration of labor, were significant: long time to rupture of membranes (239min vs. 427min p<0,01) and an unfavorable Bishop score at rupture (p=0,003). In both groups, the complications were placental retention and the occurrence of fever during labor.

CONCLUSION

Two main factors affecting labor duration were identified in this study (term and nulliparity). This knowledge could allow women to be better informed about the expected time of labor and the potential associated risks.

To compare the methods of pregnancy termination for fetal abnormality in the first and second trimesters

Fetal abnormality is a major cause of termination of pregnancy and preservation of the fetus is important for confirmation of the diagnosis. Various regimes have been reported for termination of pregnancy for fetal abnormality in the first and the second trimesters. In this paper, we compare those regimes that allow preservation of the fetus, in terms of the efficacy in expulsion of the fetus, the factors and the side effects.