Myomectomy was performed on a 31 year old primigravida during the 15th week of pregnancy due to a large myoma which was 23 cm in diameter. At the 39th week of pregnancy, during the Caesarean section, eight fibroids obstructing the lower part of the uterus were removed. There were no maternal or fetal complications.

No abstract

isoprostol, a synthetic analogue of prostaglandin E 1 , is gaining popularity for use in second-trimester pregnancy termination worldwide, and several studies have reported excellent results with its use in the second trimester of pregnancy.1,2 In women with previous cesarean delivery, the use of prostaglandins for labor induction during the second or third trimester is considered dangerous because of the risk of uterine rupture.3,4 The incidence of this complication after misoprostol administration in women with a scarred uterus in the second trimester is unknown. In a retrospective study examining whether a previous cesarean delivery carries a higher risk of complications in women who undergo pregnancy termination with misoprostol, no increased risk of uterine rupture was found. 5In this report, we describe a case of uterine rupture during a second-trimester pregnancy termination with misoprostol in a woman with a previous cesarean delivery. Apart from the clinical symptoms, the diagnosis was based on the sonographic findings that prompted surgical intervention. Case ReportA healthy 22-year-old woman, gravida 2, was admitted at 23 weeks' gestation, to our hospital for pregnancy termination after prenatal diagnosis of spina bifida. The patient's medical history was unremarkable. The obstetric history included 1 prior cesarean delivery 2 years earlier because of cephalopelvic disproportion, which was uncomplicated. Four hundred micrograms of oral misoprostol and 400 µg of intravaginal misoprostol were given initially. The same dose (400 µg) of intravaginal misoprostol was repeated 8 hours later. Two hours after the second administration, the patient had vaginal bleeding, and digital examination showed 3-cm cervical dilatation with intact membranes. Regular uterine contractions every 5 minutes were also observed.