[Use of misoprostol for induction of labor in case of fetal death or termination of pregnancy during second or third trimester of pregnancy: Efficiency, dosage, route of administration, side effects, use in case of uterine scar].
OBJECTIVE
Study, based on the literature, of the use of misoprostol for induction of labor in cases of second or third trimester fetal death or termination of pregnancy and define the different mode of administration.


METHODS
Bibliographic review using the Medline and Pubmed databases and the guidelines of the international professional societies. Selection of papers in French and English. Keywords used: misoprostol, termination of pregnancy, mid and third trimester, scarred uterus, previous cesarean section, uterine rupture.


RESULTS
Misoprostol is effective for induction of labor in case of second or third fetal death or termination of pregnancy. Comparing to oral route, vaginal route reduces the induction-expulsion time and the rate of patients remaining undelivered in the first 24 hours without increasing side effects. Oral route is a possible alternative if preferred by the patient. Sublingual route seems interesting but data are limited. The use of moderate doses (800-2400 μg/day) every 3 to 6 hours seems to be the best compromise between efficiency and tolerance. It is not possible to recommend a specific dosing schedule. The risk of uterine rupture in case of previous cesarean section justifies the use of minimum effective dose for these patients. In this case, it is recommended not to exceed a dose of 100 μg for each dose. The induction-birth period and doses of misoprostol required to induce labor are reduced when combined with mifepristone administered 36 to 48 hours before.


CONCLUSIONS
Misoprostol is effective and safe for induction of labor in case of second or third trimester fetal death or termination of pregnancy.
Clinique d'obstétrique, pôle « femme-mère-nouveau-né », hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France. Electronic address: elodie.clouqueur@chru-lille.fr.
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Clouqueur
Clinique d'obstétrique, pôle « femme-mère-nouveau-né », hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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Coulon
Clinique d'obstétrique, pôle « femme-mère-nouveau-né », hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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Vaast
Clinique d'obstétrique, pôle « femme-mère-nouveau-né », hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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Chauvet
Clinique d'obstétrique, pôle « femme-mère-nouveau-né », hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Faculté de médecine, université Lille - Nord-de-France, 59045 Lille cedex, France.
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Deruelle
Clinique d'obstétrique, pôle « femme-mère-nouveau-né », hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Faculté de médecine, université Lille - Nord-de-France, 59045 Lille cedex, France.
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Subtil
Clinique d'obstétrique, pôle « femme-mère-nouveau-né », hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Faculté de médecine, université Lille - Nord-de-France, 59045 Lille cedex, France.
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Houfflin-Debarge
D000020:Abortifacient Agents, Nonsteroidal; D000028:Abortion, Induced / Q000379:methods*; D002585:Cesarean Section / Q000009:adverse effects; D002921:Cicatrix; D004651:Employment; D005260:Female; D005313:Fetal Death; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000379:methods*; D016239:MEDLINE; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects*; D010120:Oxytocics; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012307:Risk Factors; D014597:Uterine Rupture; D014599:Uterus / Q000473:pathology*
D000020:Abortifacient Agents, Nonsteroidal; D010120:Oxytocics; D016595:Misoprostol
Interruption médicale de grossesse; Intrauterine death; Misoprostol; Mort in utero; Termination of pregnancy