An experience with the use of Misoprostol in second trimester miscarriages, in women with prior cesarean births

Objective: To determine the success rate, frequency of complications and, side effects of misoprostol used, for second-trimester miscarriages, in women with history of previous cesarean section. Methodology: This cross sectional study was done at Lady Reading Hospital, Peshawar, from January 2021 to December 2022.The sample included 90 women, with a history of previous one cesarean section, undergoing medical management of second-trimester miscarriage. Outcomes noted were, success rate, frequency of scar complications and side effects. Results: The mean age of sample of 90 patients, was 28.87±4.6. The mean induction to expulsion time was 11 hours ± 3.9. Complete expulsion was achieved in 67.7% (61/90) cases. The need for surgical evacuation of retained products of conception, was observed in 32.5% (29/90) of cases. Scar complications were noted in 2.2% (2/90) cases. The need for surgical evacuation was more common with the vaginal route of administration as compared to the sublingual route i.e. 50% (20/40) vs 18% (09/50), p-0.001. Diarrhea was significantly associated with sublingual route of administration, p-0.001. Fever was common with the vaginal route, 47.5% (19/40) vs 26% (13/50), p-0.03. The mean induction to termination time was significantly shorter in the sublingual route group. (p-0.001) Conclusion: Misoprostol successfully and safely concludes the process of second trimester miscarriage in carefully selected women with a history of previous one cesarean birth.