Vaginal misoprostol for second-trimester pregnancy termination after one previous cesarean delivery
Received 25 April 2009; received in revised form 30 July 2009; accepted 25 August 2009. published online 25 September 2009.
Abstract
Objective
To determine the safety and efficacy of using misoprostol vaginally for second-trimester abortion in women with a single previous cesarean delivery.
Method
This prospective observational study was carried out at a university hospital in Egypt with 50 pregnant women with 1 previous cesarean delivery; a gestation of at least 16 weeks but less than 20 weeks (group 1) or 20 or more weeks (group 2); and a need to terminate the pregnancy. The regimen was 4 doses of 200 μg of misoprostol applied vaginally every 4 hours daily, with a 12-hour nightly rest from misoprostol applications, until contractions appeared but not for more than 72 hours. The primary outcome was the induction-to-abortion interval.
Results
There were no cases of uterine rupture. Abortion within the study protocol occurred in 45 of the 50 women, for a 90% success rate. There was no significant difference in the induction-to-abortion interval between the 2 groups.
Conclusion
Inducing abortion with lower misoprostol doses appear to be safe and effective throughout the second trimester in women with a single previous cesarean delivery. Larger randomized trials are needed to validate these results.
aDepartment of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Ain Shams University, Cairo, Egypt
bDepartment of Obstetrics and Gynecology, Dudley Group of Hospitals NHS Foundation Trust, Russell's Hall Hospital, Dudley, UK
Corresponding author. Dudley Group of Hospitals NHS Foundation Trust, North Wing, Russell's Hall Hospital, Dudley, West Midlands, United Kingdom, DY1 2HQ. Tel.: +44 1384 456 111; fax: +44 1384 244 445.
ABSTRACT