Induction of labor with vaginal misoprostol for second trimester termination of pregnancy in the scarred uterus

OBJECTIVES: To assess the safety of vaginal misoprostol for second trimester pregnancy termination in patients with a history of cesarean section. METHODS: A consecutive series of 593 women with pregnancies of 14-26 weeks were studied. A cohort of 56 cases had undergone previous cesarean section delivery. The 528 cases who had no history of prior uterine surgery served as the controls. The termination was carried out according to the regimen used at the time of enrollment, either 600 microg applied at every 6 or every 12 h, or 800 microg applied at every 12 h using the vaginal route. RESULTS: The median induction to abortion time in the previous cesarean section group (15.1 h) was not significantly different from that of the controls (15.8 h). The median total dosage of misoprostol used was the same for both groups (1200 microg). The rates of incomplete abortion and analgesia usage were significantly higher in the previous cesarean section group as compared with the controls. CONCLUSIONS: Vaginal misoprostol was effective for the second trimester pregnancy termination but the safety of misoprostol in the scarred uterus cannot be assumed from this study. A large series is needed to reach the power to see the difference.