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Poster Session 1

(317) Failure rate of first trimester medical termination of pregnancy, after bariatric surgery – retrospective study

Thursday, January 30, 2025
10:30 AM – 12:30 PM  

    Coauthor(s)

  • SI

    Shay Ingram

    Medical student
    The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
    Haifa, Hefa, Israel

  • UK

    Uri Kaplan, MD

    General Surgery B
    Emek Medical Center, Afula, Israel
    Afula, HaZafon, Israel

  • GG

    Gali Garmi, MD

    Department of Obstetrics and Gynecology
    Emek Medical Center, Afula, Israel
    Afula, HaZafon, Israel

    • Submitting Author and Presenting Author(s)

  • NZ

    Noah Zafran, MBA, MD (she/her/hers)

    Department of Obstetrics and Gynecology
    Emek Medical Center, Afula, Israel
    Afula, HaZafon, Israel

Objective:

First trimester termination of pregnancy (TOP) is a common event. Approximately 50% of TOP are medical. Bariatric surgery (BS) is divided into restrictive procedures (adjustable gastric banding or sleeve gastrectomy) and malabsorptive procedures (mini gastric bypass or roux-en-Y gastric bypass). The objective of this study was to compare failure rate of first trimester medical TOP, among women who underwent BS prior to TOP, with women without previous BS.

Study Design:

This Retrospective study, conducted on data collected between January 2019 and April 2024, in a single hospital in Israel. Our protocol enables TOP up to 9 weeks of gestation and utilizes oral mifepristone 200 mg followed by buccal misoprostol 800 mg, 48 hours apart. The study cohort consisted of consecutive women who underwent any BS undergoing medical TOP. The control group, matched for gestational age, had no history of BS, were collected in a 1:4 ratio. Exclusion criteria included malabsorption disorder.  The primary outcome was failure rate measured by any medical or surgical intervention further needed to achieve complete TOP.  

Results:

We identified 405 women, 81 of them underwent BS prior to TOP. Restrictive BS was performed in 43 (53.1%) women and malabsorptive BS was performed in 38 (46.9%) women. Failure rate was comparable between the study and the control group (15 (18.5%) vs. 37 (11.4%), p=0.09). Odds ratio, adjusted for smoking status, number of previous spontaneous abortions, number of previous TOP and previous cesarean section, for failure in women post BS was 1.95, CI 0.99-3.84. Failure rate was comparable between restrictive and malabsorptive BS (9 (23.7%) vs. 6 (14.0%), p=0.26). Odds ratio, adjusted for less than 2 years elapsing from BS, for failure in women post restrictive BS relative to malabsorptive BS was 3.6 CI 0.81-16.25.         

Conclusion:

Overall failure rate of medical TOP in women who underwent BS is similar to women who had no history of BS. Failure rate was comparable for both surgical approaches.