Induction of labor with vaginal misoprostol for second trimester termination of pregnancy in the scarred uterus.
OBJECTIVE
To assess the safety of vaginal misoprostol for second trimester pregnancy termination in patients with a history of cesarean section.


METHODS
A consecutive series of 593 women with pregnancies of 14-26 weeks were studied. A cohort of 56 cases had undergone previous cesarean section delivery. The 528 cases who had no history of prior uterine surgery served as the controls. The termination was carried out according to the regimen used at the time of enrollment, either 600 microg applied at every 6 or every 12 h, or 800 microg applied at every 12 h using the vaginal route.


RESULTS
The median induction to abortion time in the previous cesarean section group (15.1 h) was not significantly different from that of the controls (15.8 h). The median total dosage of misoprostol used was the same for both groups (1200 microg). The rates of incomplete abortion and analgesia usage were significantly higher in the previous cesarean section group as compared with the controls.


CONCLUSIONS
Vaginal misoprostol was effective for the second trimester pregnancy termination but the safety of misoprostol in the scarred uterus cannot be assumed from this study. A large series is needed to reach the power to see the difference.
Herabutya
Y
Y
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. ayhr@mahidol.ac.th
Chanarachakul
B
B
Punyavachira
P
P
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000032:Abortion, Therapeutic / Q000379:methods*; D000282:Administration, Intravaginal; D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007751:Labor, Induced / Q000379:methods; D008423:Maternal Age; D016595:Misoprostol / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D018566:Pregnancy, High-Risk; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000209:etiology / Q000473:pathology*
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol