{
    "abstract": "Previous caesarean section (CS) is increasingly common among women undergoing induced abortion.\nTo map and analyse existing literature on abortion safety, outcomes and management in those with previous CS.\nFour 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.\nIn 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 \u2265\u20092 CS (p\u2009<\u20090.001). Mifepristone priming did not increase the rupture rate in second-trimester MToP (p\u2009=\u20090.77). Previous CS was a modest risk factor for retained products after MToP across both trimesters (OR 1.48, CI 1.29-1.70).\nMedical 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, \u2265\u20093 previous CS and those with abnormally invasive placenta.",
    "authors": [
        {
            "affiliation": "College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.\nDepartment of Obstetrics and Gynaecology, Cairns Hospital, Cairns, Queensland, Australia.",
            "firstname": "Natalie",
            "initials": "N",
            "lastname": "Drever"
        },
        {
            "affiliation": "College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.\nDepartment of Emergency Medicine, Townsville University Hospital, Townsville, Queensland, Australia.",
            "firstname": "Vinay",
            "initials": "V",
            "lastname": "Gangathimmaiah"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Cairns Hospital, Cairns, Queensland, Australia.",
            "firstname": "Brittany",
            "initials": "B",
            "lastname": "van Der Lugt"
        },
        {
            "affiliation": "College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.\nDepartment of Obstetrics and Gynaecology, Townsville University Hospital, Townsville, Queensland, Australia.",
            "firstname": "Cecelia",
            "initials": "C",
            "lastname": "O'Brien"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Logan Hospital, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia.",
            "firstname": "Catriona",
            "initials": "C",
            "lastname": "Melville"
        },
        {
            "affiliation": "Department of Obstetrics, Gynaecology and Neonatology, School of Medicine, University of Sydney, Sydney, New South Wales, Australia.",
            "firstname": "Kirsten",
            "initials": "K",
            "lastname": "Black"
        },
        {
            "affiliation": "The Cairns Institute, James Cook University, Cairns, Queensland, Australia.",
            "firstname": "Caroline",
            "initials": "C",
            "lastname": "de Costa"
        }
    ],
    "conclusions": "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, \u2265\u20093 previous CS and those with abnormally invasive placenta.",
    "copyrights": "\u00a9 2025 The Author(s). Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.",
    "doi": "10.1111/ajo.70013",
    "journal": "The Australian & New Zealand journal of obstetrics & gynaecology",
    "keywords": [
        "abortion",
        "accreta",
        "caesarean section",
        "review",
        "termination of pregnancy"
    ],
    "methods": null,
    "publication_date": "2025-04-12",
    "pubmed_id": "40219613",
    "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 \u2265\u20092 CS (p\u2009<\u20090.001). Mifepristone priming did not increase the rupture rate in second-trimester MToP (p\u2009=\u20090.77). Previous CS was a modest risk factor for retained products after MToP across both trimesters (OR 1.48, CI 1.29-1.70).",
    "title": "Induced Abortion After Previous Caesarean Section: A Scoping Review.",
    "xml": "<Element 'PubmedArticle' at 0x788501fdb100>"
}