title: Uterine rupture associated with the use of misoprostol in the gravid patient with a previous cesarean section.
abstract: OBJECTIVE
  Our purpose is to report our experience with uterine rupture in patients undergoing a trial of labor after previous cesarean delivery in which labor was induced with misoprostol. The literature on the use of misoprostol in the setting of previous cesarean section is reviewed.
  
  
  METHODS
  This report was based on case reports, a computerized search of medical records, and literature review.
  
  
  RESULTS
  Uterine rupture occurred in 5 of 89 patients with previous cesarean delivery who had labor induced with misoprostol. The uterine rupture rate for patients attempting vaginal birth after cesarean section was significantly higher in those who received misoprostol, 5.6%, than in those who did not, 0.2% (1/423, P =.0001). Review of the literature reveals insufficient data to support the use of misoprostol in the patient with a previous cesarean delivery.
  
  
  CONCLUSIONS
  Misoprostol may increase the risk of uterine rupture in the patient with a scarred uterus. Carefully controlled studies of the risks and benefits of misoprostol are necessary before its widespread use in this setting.
authors.affiliation: Department of Obstetrics, Northwest Permanente PC, British Columbia, Canada.
authors.forename: M M
authors.initials: MM
authors.lastname: Plaut
authors.forename: M L
authors.initials: ML
authors.lastname: Schwartz
authors.forename: S L
authors.initials: SL
authors.lastname: Lubarsky
mesh_terms: D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007751:Labor, Induced; D016595:Misoprostol / Q000009:adverse effects*; D010120:Oxytocics / Q000009:adverse effects*; D011247:Pregnancy; D012307:Risk Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology*
chemical_list: D010120:Oxytocics; D016595:Misoprostol