{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T09:05:55Z","timestamp":1783069555080,"version":"3.54.6"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T00:00:00Z","timestamp":1676419200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>To assess clinical outcomes and complications in women with \u22651 prior caesarean delivery (CS) during mid\u2010pregnancy medical abortion with misoprostol following mifepristone priming.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Retrospective analysis of abortions at 13\u201328\u2009weeks gestation using sequential mifepristone and misoprostol at a single centre from 1\/2008\u201312\/2018. Procedural outcomes were compared between cases with no prior CS, one prior and \u22652 prior CS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 1399 consecutive women who underwent a medical abortion, with 304 (21.7%) having \u22651 prior lower segment CS (241 one, 49 two, 12 three, one four) and one a prior classical CS. Median gestation was 19\u2009weeks (interquartile range (IQR) 17\u201321) among nulliparas, multiparas with no prior CS and multiparas with prior CS, <jats:italic>P<\/jats:italic>\u00a0=\u20090.505. Compared with nulliparas (median procedural duration 10.8\u2009h, IQR 7.5\u201316.5; adjusted hazards ratio (aHR)\u00a0=\u00a01.20 95%CI 1.04\u20131.40, <jats:italic>P<\/jats:italic>\u00a0=\u20090.015), multiparas with prior CS had a shorter procedural duration (9.5\u2009h, IQR 6.5\u201313.5) while multiparas with no CS had the shortest duration (7.0\u2009h, IQR 5.0\u20139.8; aHR\u00a0=\u00a02.28 95%CI 2.01\u20132.58, <jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001). Complications were more frequent with prior CS: estimated blood loss (medians: 100\u2009cc no CS vs 150\u2009cc \u22651 CS, <jats:italic>P<\/jats:italic>\u00a0=\u20090.002), blood loss &gt;1000\u2009cc (3.6% no CS vs 7.2% \u22651 CS; odds ratio (OR)\u00a0=\u00a02.11 95%CI 1.23\u20133.62, <jats:italic>P<\/jats:italic>\u00a0=\u20090.007) and placental retention (17.3% no CS vs 25.3% \u22651 CS; adjusted OR\u00a0=\u00a01.44 95%CI 1.05\u20131.99, <jats:italic>P<\/jats:italic>\u00a0=\u20090.024). Uterine rupture occurred in 4\/304 women with \u22651 prior CS (1.3%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Mifepristone\u2010misoprostol abortion in women with prior CS is generally safe but associated with an increased risk of procedural complications. Lowering of the misoprostol dosage with prior CS may reduce uterine rupture, although this hypothesis requires ongoing research.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.13653","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T10:16:36Z","timestamp":1676456196000},"page":"301-307","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Mifepristone priming and subsequent misoprostol for second trimester medical abortion in women with previous caesarean delivery"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3928-3290","authenticated-orcid":false,"given":"Jan E.","family":"Dickinson","sequence":"first","affiliation":[{"name":"Maternal Fetal Medicine, Division of Obstetrics and Gynaecology The University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5507-9065","authenticated-orcid":false,"given":"Dorota A.","family":"Doherty","sequence":"additional","affiliation":[{"name":"Biostatistics and Research Design Unit, Division of Obstetrics and Gynaecology The University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Australia's mothers and babies . 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