Misoprostol for second trimester abortion in women with prior uterine incisions

Purpose: Termination of pregnancy in the second trimester with misoprostol is safe and effective, but there is very limited published experience of its use in women with one or more previous cesarean sections. Uterine rupture might occur when misoprostol and oxytocin are used for pregnancy termination at the second trimester in women with previous uterine scars. In the English literature there are some case-series of studied women with a history of previous cesarean sections, in which misoprostol was used for second trimester termination of pregnancy. However, many different protocols have been used with different doses of misoprostol and different intervals between doses and it is difficult to draw definite conclusions. Therefore, the decision to attempt pregnancy termination in the second trimester in cases with previous uterine scar should be made on a case-by-case basis, after consideration of the number of previous cesarean sections and gestational age, and careful labor monitoring of these patients.