Uterine rupture following misoprostol improper use

Abstract

Introduction: Misoprostol, a synthetic prostaglandin E1 analogue, is considered safe and is being used worldwide for second trimester pregnancy terminations, with successful results. However, complications of uterine rupture and hysterectomy have been reported, and the incidence is higher among women with prior cesarean scar. Maternal morbidity and mortality following induced abortions are directly proportional to the gestational age at termination. We report a case of a 32-year-old multipara, G3P2, with two prior low transverse cesarean sections, who experienced uterine rupture after vaginal misoprostol administration, following an illegal second trimester abortion of an undesired pregnancy of about 20 weeks’ gestation. She presented at emergency room complaining of acute lower abdominal pain and sparse vaginal hemorrhage. Fetal demise and uterine rupture were diagnosed by manual vaginal exam and ultrasound. She underwent emergency exploratory laparotomy that revealed massive hemorrhage arising from a complete and extended uterine rupture from the previous cesarean section scar. A total hysterectomy and intra-operative blood transfusion had to be performed. Her post-operative was uneventful.