Misoprostol for midtrimester termination of pregnancy in women with 1 or more prior cesarean deliveries

Abstract

Misoprostol inserted vaginally was effective for midtrimester TOP but the safety of using misoprostol in women with 2 or more prior CDs cannot be confirmed from the present study. Misoprostol should be used carefully, particularly in women with 2 or more prior CDs.

Misoprostol use for second‐trimester termination of pregnancy among women with one or more previous cesarean deliveries

“…In the present study, the median duration of termination was longer for women with two previous cesareans than for those with one procedure. The median induction‐to‐expulsion time was shorter than that reported by other authors, who noted durations ranging from 14.5 to 42.6 hours using different regimens. In the present study, the high‐loading vaginal dose used in regimen 1 is likely to increase the uterine response, leading to stronger contractions faster as compared with lower doses.…”

“…Studies on the use of misoprostol alone among women with previous cesareans are limited, and a lack of randomized trials makes it difficult to draw conclusions . Despite the evidence that misoprostol is effective, its safety for use among women with one or more previous cesareans remains uncertain …”

“…In some studies, the misoprostol regimen was supplemented with an additional rectal dose when products of conception were retained; in others, oxytocin was administered after fetal expulsion to complete the abortion, with no increase in complications . The misoprostol regimen administered at the study clinic uses lower doses than reported in other regimens …”

“…The drug is also stable at ambient temperature and less costly than other methods . Although misoprostol is considered safe for second‐trimester terminations, the safety of its use for women with a uterine scar remains uncertain …”

Mort fœtale in utero au-delà de 14SA : induction du travail et obtention de la vacuité utérine

“…Une é tude utilisant du misoprostol intravaginal à demi-dose (200 mg toutes les 6 heures) en cas d'interruptions de grossesse entre 13 et 26 SA chez 31 patientes porteuses d'un uté rus tricicatriciel, comparé es à un groupe té moin de 107 femmes sans anté cé dent de cé sarienne, n'a observé aucune rupture uté rine et des taux de succè s comparables [51]. Par contre, une autre é tude ré trospective observait 11 % de ruptures uté rines parmi 26 femmes ayant au moins deux cé sariennes avec l'usage du misoprostol par voie vaginale (200 mg toutes les 4 heures) en cas d'interruption de la grossesse entre 14 et 26 SA pour un taux de succè s de 76 % [52].…”