The use of vaginal misoprostol for second-trimester pregnancy termination in women with previous single cesarean section

Introduction: This retrospective study reports of 85 women in the second trimester with one prior cesarean section undergoing medical abortion of a viable unwanted pregnancy using vaginal misoprostol. Two regimens that were selected in a nonrandomized manner were used. Materials and Methods: Eighty-five women treated with vaginal misoprostol in a 3-year period were retrospectively analyzed. All received 400 mu g of misoprostol initially and 22 (25.8%) aborted. Then Group A (n=43) received subsequent administration of 200 mu g every 6 h, whereas Group B (n=20) received 400 mu g/6 h. Results: All patients aborted. The groups had no statistical difference in mean age, gravidity, parity, gestational age, and time from previous cesarean section, and there was no difference in occurrence of side effects and mean induction to abortion time interval. The lower dosage group received a median of 600 mu g of vaginal misoprostol (min 600 mu g to max 1000 mu g). There were no uterine ruptures, need for hysterotomy, or excess bleeding in any patient. Conclusions: This is the largest series reported to date of second-trimester pregnancy termination in cases with one previous cesarean section using only vaginal misoprostol. The study shows that both used regimens are safe and equally effective. All 85 women aborted. (c) 2006 Elsevier Inc. All rights reserved.