Misoprostol for termination of mid-trimester post-Caesarean pregnancy

OBJECTIVE: To evaluate the efficacy and safety of PGE1 analogue, misoprostol, for inducing abortion or labour during mid-trimester in women who have had a prior Caesarean section (one or more). STUDY DESIGN: Women who had to undergo termination of pregnancy between 13 and 26 weeks of gestation for various indications and who had at least one previous Caesarean section were studied over a period of two and a half years. The standard regimen for misoprostol in all the cases was 400 microg up to 20 weeks of gestation and 200 microg for pregnancies longer than 20 weeks, either vaginally or sublingually every six hours (up to maximum 24 h). A contemporaneous cohort of women undergoing the same procedure for similar indications but without scarred uteri served as control. RESULTS: Eighty women in the study group underwent termination procedures for unwanted pregnancy, missed abortion, fetal anomaly or fetal death. The median induction-abortion interval was 16.4 h (10-21 h) and did not differ much from that in women without previous Caesarean delivery (median: 15.6 h; range 9.6-20 h), P > 0.05. Misoprostol was found to be safe in our cohort of post-Caesarean women and there was no case of scar rupture or dehiscence. No significant differences in rates of incomplete abortions, blood loss or sepsis were detected in the study group compared to the control group. CONCLUSION: The use of misoprostol for mid-trimester pregnancy termination is not contraindicated in women with Caesarean scar and is effective and comparable with those in women without scarred uteri.