Efficacy and safety of early feticide for medical termination of pregnancy in women with a scarred uterus: A bicentric retrospective cohort study

OBJECTIVE: To evaluate the efficacy and safety of early feticide for medical termination of pregnancy in women with a scarred uterus. METHODS: This was a bicentric retrospective cohort study involving women with a scarred uterus who underwent medical termination of pregnancy between 16 and 32 weeks of gestation from 2009 to 2023 at the University Hospitals of Rouen and Caen, France. Women were divided into two groups: the early feticide group (i.e. feticide performed before onset of labor), and the control group (i.e. feticide performed at onset of labor or not performed at all). The primary outcome was the rate of vaginal delivery within 12 h of onset of labor. RESULTS: 96 women were enrolled, 22 in the early feticide group and 74 in the control group. The rate of vaginal delivery within 12 h (86.4 % vs. 75.7 %, P = 0.22) and the median onset of labor-to-delivery interval (5.12 vs. 7.37 h, P = 0.11) were comparable between the two groups. Use of misoprostol was significantly less frequent in the early feticide group than in the control group (72.7 % vs. 96 %, P = 0.004). Overall maternal morbidity was comparable between the two groups, with one case of uterine rupture reported in each group. In utero maceration rendered fetal autopsy and neuropathological analysis infeasible in the early feticide group. CONCLUSION: Early feticide was not associated with a statistically significant reduction in the proportion of deliveries occurring within 12 h of labor onset; however, it was associated with reduced use of misoprostol and increased frequency of spontaneous onset of labor, without increased maternal complications.