Interruption of Pregnancy in Women with the Uterine Scar: Potential Risks

*Galina Dikke and Vladimir Ostromenskiy*

### **Abstract**

Summary objective: To assess the risks and identify effective and safe methods of abortion in women with uterine scar. Material: Literary sources published in the databases of Medline, PubMed, and others, of which 57 are included in this review. The main provisions: Termination of pregnancy in women with a scar on the uterus involves the use of any available method. For women with a scar on the uterus, it is necessary to prepare the cervix before a surgical abortion in all terms. Abnormal implantation of the embryo within the fibrous tissue of the scar after caesarean section can cause life-threatening bleeding of the mother during or after the termination of the pregnancy. Surgical excision of the affected area by hysteroscopic access, as well as transvaginal or transabdominal local administration of Methotrexate with or without an additional intramuscular dose of the same drug, seems to be optimal from the point of view of minimizing the frequency of complications. Conclusion: A scar on the uterus after caesarean section presents a high risk of abnormal attachment of the ovum and fatal bleeding during abortion.

**Keywords:** medical abortion, surgical abortion, uterine scar, bleeding

#### **1. Introduction**

Interruption of pregnancy in patients with uterine scar, as well as in women without it, can be artificial (in early and late pregnancy period if medically required, and also in pregnancy period exceeding 22 weeks—at still birth) or spontaneous.

Although there is no doubt presently that now caesarean section is quite a safe procedure, it still presents a certain risk not only for the subsequent pregnancy and confinement, but also in case of its interruption.

Interruption of pregnancy in women with uterine scar assumes the use of any accessible method [1]. However, the abortion made by the method of uterine curettage in the interval period aggravates the forecast. The risk of scar inadequacy in this case increases 1.5 times.

Recently, substantial growth of registered cases of localisation of ovum in the uterine scar after previous caesarean section has been observed [2]. After one or several caesarean section operations, the specific localisation of the chorion, such as presentation and scar increta, can be a reason of serious complications during and after interruption of pregnancy.
