Misoprostol complications in second-trimester termination of pregnancy among women with a history of more than one cesarean section

Abstract

Objective This study aims to investigate the complications due to misoprostol administration for second-trimester termination of pregnancy among women with history of 2 or more cesarean scarring. Methods The cohort of this retrospective study included 678 subjects who required second-trimester pregnancy termination, from 2013 to 2015 and treated with vaginal misoprostol of 100 to 400 µg. The subjects were divided into 3 groups based on their history of cesarean sections: without a history of cesarean section, with a history of one cesarean section, and with a history of more than one cesarean section and uterine scaring. Results The results showed that the success rate of misoprostol administration for pregnancy termination was 95.72%. The rate of bleeding as a complication was significantly higher in subjects with a history of more than one cesarean section than in other participants (risk ratio [RR], 2.24; 95% confidence interval [CI], 1.11-4.0). The incidence of uterine rupture was higher in the group with a history of more than one cesarean section than in other groups. However, no significant difference was observed between the groups (RR, 1.44; 95% CI, 0.27-7.6). There was a significant relationship between the need for other auxiliary treatments in the pregnancy termination and the history of uterine scarring (RR, 3.3; 95% CI, 1.23-9.1). Conclusion The present study showed that pregnancy termination using smaller divided dose of misoprostol in patients with previous history of cesarean scarring may be associated with lower incidence of uterine rupture.

Reactions to Misoprostol: A Case Report

“…2 Most of previous studies found no adverse cardiovascular effects following the use of misoprostol. [13][14][15][16] However, some studies reported cardiovascular effects related to misoprostol. The French Regional Pharmacovigilance Centre 17 reported 63 cases of cardiovascular effects related to misoprostol, seven of them being angina, and they have identified some cardiovascular risk factors related to these adverse effects, such as age > 35 years, smoking or high doses of vaginal misoprostol.…”

Comparative study of combination of misoprostol with Foley’s bulb compared with misoprostol alone for termination of second trimester pregnancy

“…Data which we found in our observational study were almost similar as shown by Jamali et al study where 13.2% cases reported complications. 17 These include bleeding, need for blood transfusion and curettage. Teratogenic effects were reported with failed abortion and attempted to continue pregnancy after administration of misoprostol.…”