Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review

Abstract

Background Misoprostol is an effective medical method for the management of pregnancy loss. However, data on its efficacy and safety in women with previous cesarean deliveries are limited. Case presentation We report a 36-year-old patient, gravida 11 para 6, with a diagnosis of missed miscarriage at 15 weeks of gestation. The patient had a significant obstetric history of previous five cesarean deliveries and uterine rupture. Following patient counseling about the medical and surgical options of managing her miscarriage, the patient opted for medical method. Low-dose misoprostol of 100 µg was inserted vaginally and repeated again after 6 hours. The patient had an uneventful complete miscarriage following the second dose of misoprostol. No uterine rupture, no extra vaginal bleeding, and no blood transfusion were observed. Conclusion We conclude that adopting a low-dose misoprostol protocol could be potentially safe and effective in managing second trimester missed miscarriage in women with repeated cesarean deliveries and/or uterine rupture history. Further studies are needed to confirm these results.

Misoprostol and mid trimester termination of pregnancy in patients with two previous scars and more at Elwiya Maternity Teaching Hospital

“…(1%), obstetricians continue to see it as a hazard. 12 Misoprostol offers a number of benefits over other prostaglandin preparations for 2 nd trimester termination, including its low price and being stable at room temperature.…”

“…22,25 Low-dose Misoprostol (100 µg), however, was found to be potentially effective and safe in the management of second-trimester abortions in women with repeated cesarean deliveries. 12 We have reported two incidences of uterine rupture, with both 100 and 200µg. Both were after 18 h (6 doses) from induction beginning.…”

Misoprostol e interrupção da gravidez no meio do trimestre em pacientes com duas cicatrizes anteriores e mais no Elwiya Maternity Teaching Hospital

“…(1%), os obstetras continuam a vê-lo como um perigo. 12 O misoprostol oferece uma série de vantagens em relação a outras preparações de prostaglandinas para a interrupção da gravidez no segundo trimestre, incluindo o seu baixo preço e o fato de ser estável à temperatura ambiente. Pode ser administrado por via vaginal ou oral e provou ser eficaz numa série de doses diferentes.…”

“…22,25 O misoprostol em dose baixa (100 µg), no entanto, foi considerado potencialmente eficaz e seguro no tratamento de abortos do segundo trimestre em mulheres com cesarianas repetidas. 12 Registramos duas incidências de ruptura uterina, tanto com 100 como com 200 µg. Ambas ocorreram após 18 horas (6 doses) do início da indução.…”