Misoprostol for midtrimester termination of pregnancy in women with 1 or more prior cesarean deliveries

Abstract

ObjectiveTo evaluate the safety and efficacy of vaginal misoprostol for midtrimester termination of pregnancy (TOP) in women with 1 or more prior cesarean deliveries (CDs). MethodsA retrospective study was conducted with 279 women undergoing TOP with vaginal misoprostol between 14 and 26weeks of gestation. Of these, 193 had no uterine scars (group 1), 60 had 1 prior CD (group 2), and 26 had 2 or more prior CDs (group 3). The primary outcome was the success rate of TOP. Secondary outcomes were time from induction to abortion, total dose of misoprostol used, and occurrence of uterine rupture. ResultsThe success rates were 96.4% in group 1, 81.7% in group 2, and 76.9% in group 3 (P=0.001). Time from induction to abortion, total dose misoprostol, and duration of hospital stay differed significantly among the groups (P=0.001 for all variables). There were 3 cases (11.5%) of uterine rupture in group 3, for an overall rate of 1.1%. ConclusionMisoprostol inserted vaginally was effective for midtrimester TOP but the safety of using misoprostol in women with 2 or more prior CDs cannot be confirmed from the present study. Misoprostol should be used carefully, particularly in women with 2 or more prior CDs.