Misoprostol for Second Trimester Pregnancy Termination in a scarred uterus

摘要

With the expanding subpopulation of women with prior cesarean. births, second trimester pregnancy termination in patients with a prior cesarean delivery has become an increasing lycommon circumstance facing obstetricians. Objective: determine the safety and efficacy of vaginal misoprostol in termination of second trimester pregnancy in women with prior uterine incisions. Patients and methods: This is a case series study that was included 50 patients in their 13 26th ‐ week's gestation according to dates or first trimestric ultrasonography, with previous one or two lower segment cesarean section in whom termination of pregnancy was indicated either due to intrauterine fetal demise or lethal structural anomalies. Results: Successful termination was generally considered to be the expulsion of the fetus within 72 h. In our study, the overall success rate was 92 % with 18.7 ± 9.8 hours mean induction– abortion interval 18.3 ± 9.3 hours in patients of the second group (range: 6.5 – 38.0 hours). This relatively long duration may be attributed to the relatively small dose we used Misoprostol 200 μg vaginally or sublingual or buccal every 4 hours up to 4 doses within 72 hours only. N.B. we avoid vaginal route if bleeding and/or signs of infection. Conclusion: The use of the prostaglandin E1 analogue, misoprostol, in a dose of 200 μg /4 hours is safe and effective for induction of second trimestric abortion in women with previous uterine incisions.