Safest thing to do to wait for body to go into labor. Research that monitored such things showed risk of massive hyper blood coagulation does not begin until over 4 months of carrying a dead fetus If woman wants to terminate, follow regular protocol for induction and expect it to be slow as any second trimester induction- at least 48 hours on average. But it is safer to wait.
There really are no RCTs on the subject of 2nd trimester abortion with previous Caesarean. Several trials of D&E vs induction for 2nd trimester termination of pregnancy were prematurely halted due to poor enrollment or follow-up.
That leaves us with observational studies. These basically show that major complications are similar in both D&E and induction, but induction has a higher likelyhood of minor complications, notably retained placenta and readmission for infection/retained placental products.
Berghella and Ben-Ami specifically looked at 2nd trimester abortions in women with prior Caesarean deliveries. Ben-Ami et al compared 2nd trimester D&E in women with and without prior Caesarean and the only differenc ein complications was that cervical laceration was more common in women with a prior Caesarean.
Berghella found 2 cases of uterine rupture in 461 cases of 2nd trimester labour induction abortion (0.4%) in women with 1 prior Caesarean.
Pubmed links to the articles below:
http://www.ncbi.nlm.nih.gov/pubmed/19438490
http://www.ncbi.nlm.nih.gov/pubmed/19539892
The long and short of it is that there is no compelling evidence to suggest one method over another so it is a decision to be made between the woman and her care provider. Local expertise with D&E varies so that certainly influences the options as well.
The risks of induction are many times higher and more serious than the risk of hypercoagulation.
Judy, this isn't about the risk of coagulation defect at all. This is about women who choose not to await spontanous abortion with a fetal demise, or those who wish to terminate a pregnancy with fetal malformation. Many fetal malformations can survive into the late third trimester (at which times it is illegal in many places to have a pregnancy termination) or even to birth. This is just not an acceptable option for many women.
As I wrote in my first post, that in those cases, use standard induction methods. Right. Agree. No argument. of course.
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