Vaginal misoprostol for second-trimester pregnancy termination after one previous cesarean delivery.
OBJECTIVE
To determine the safety and efficacy of using misoprostol vaginally for second-trimester abortion in women with a single previous cesarean delivery.


METHODS
This prospective observational study was carried out at a university hospital in Egypt with 50 pregnant women with 1 previous cesarean delivery; a gestation of at least 16 weeks but less than 20 weeks (group 1) or 20 or more weeks (group 2); and a need to terminate the pregnancy. The regimen was 4 doses of 200 microg of misoprostol applied vaginally every 4 hours daily, with a 12-hour nightly rest from misoprostol applications, until contractions appeared but not for more than 72 hours. The primary outcome was the induction-to-abortion interval.


RESULTS
There were no cases of uterine rupture. Abortion within the study protocol occurred in 45 of the 50 women, for a 90% success rate. There was no significant difference in the induction-to-abortion interval between the 2 groups.


CONCLUSIONS
Inducing abortion with lower misoprostol doses appear to be safe and effective throughout the second trimester in women with a single previous cesarean delivery. Larger randomized trials are needed to validate these results.
Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Ain Shams University, Cairo, Egypt.
Ahmad H
AH
Naguib
Hassan M
HM
Morsi
Tamer F
TF
Borg
Salah T
ST
Fayed
Hosam M
HM
Hemeda
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000028:Abortion, Induced / Q000009:adverse effects / Q000379:methods*; D000282:Administration, Intravaginal; D002585:Cesarean Section; D004534:Egypt; D005260:Female; D005865:Gestational Age; D006785:Hospitals, University; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol