Misoprostol for termination of mid‐trimester post‐Caesarean pregnancy

Abstract

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.

How to manage unresponsiveness to misoprostol in failed second trimester pregnancy termination

“…Similar to other studies, 4,5,16,17 the present study also did not experience any serious complications.…”

“…In failed termination, additional vaginal misoprostol might work in some instances and can be tried. Similar to other studies, 4,5,16,17 misoprostol was equally safe and effective in scarred and non‐scarred uterus.…”

“…Only a few studies mention methods of managing such women. Some studies 4,5 have suggested that hysterotomy should be preferred in women who have undergone previous cesarean section.…”

Vaginal misoprostol for second‐trimester pregnancy termination after one previous cesarean delivery

“…While misoprostol is available in Egypt, Chapman et al [9] reported a higher incidence of uterine rupture and hemorrhage with this drug than with mifepristone for women with cesarean scars, whereas others have shown it to be relatively safe [7,12,13]. These conflicting reports have led to suggest that the safety of misoprostol is yet to be established for these women [14].…”

“…There, too, no cases of uterine rupture occurred. Bhattacharjee et al [14] used misoprostol vaginally or sublingually every 6 hours, up to a maximum of 24 hours. The dosage was 400 μg when the gestation duration was less than 20 weeks and 200 μg when it was 20 weeks or longer.…”