Uterine rupture during induction of labor at term with intravaginal misoprostol

Background: Misoprostol (prostaglandin E-1) compares favorably with dinoprostone (prostaglandin E-1) and oxytocin for labor induction at term. Excessive uterine activity has been reported using high-dose regimens, but no negative effect on outcomes has been observed. Case: Labor was induced in a 34-year-old multipara at 39 weeks' gestation using intravaginal misoprostol tablets. Five hours after administration of the second 25-mu g dose, fetal bradycardia prompted emergency cesarean delivery. Hysterectomy and left salpingo-oophorectomy were necessary to control bleeding from a 15-cm posterior uterine wall rupture. Conclusion: Misoprostol can cause excessive uterine activity and uterine rupture. (C) 1997 by The American College of Obstetricians and Gynecologists.