Low-dose misoprostol for second trimester pregnancy termination in women with a prior caesarean delivery

Abstract

Introduction: Termination of Pregnancy (ToP) is an obstetric procedure that can be performed by surgical or medical techniques during the first or second trimester of pregnancy. Medical ToP is recommended in the second trimester owing to its low rate of maternal morbidity. Low-dose misoprostol is an effective option in such cases. Aim: To compare the safety and efficacy of two different vaginal misoprostol regimens for ToP in the second trimester in women with previous Caesarean Deliveries (CDs), against controls. Materials and Methods: This retrospective study was conducted at a university hospital, between January 2005 to December 2014. The study cohort was divided into two groups: history of CD (Group I, n=85) and control (Group II, n=434). The method used for ToP was chosen with respect to history of CD. Four doses of 50 mu g misoprostol and 4 doses of 200 mu g misoprostol were applied vaginally each day, until regular uterine contractions were observed, to Groups I and II, respectively. Indication of ToP, gestational the ToP (weeks), duration from induction to abortion (hours), total misoprostol dose (pg), foetal weight (gram), post-abortion hospitalisation time (day), and any complications were recorded. The Chi-square or Fisher's-Exact test was used for qualitative data, and the Student's t-test or Mann-Whitney U-test was used for quantitative data. The p<0.05 was considered significant. Tests were performed using the SPSS statistical package for Windows, version 17 (SPSS, Chicago, Illinois, USA). Results: The success rate of termination was 91.8% (78/85) in Group I and 99.1% (430/434) in Group II (p<0.001). The median induction to abortion interval was 54.08 +/- 42.85 hours for Group I and 47.19 +/- 31.39 hours in Group II (p=0.371). One case of uterine rupture was recorded in Group I (p=0.164). The incidence of requiring transfusion for haemorrhages was higher in Group I than in Group II (5.9% vs. 1.6%, respectively, p=0.032). Conclusion: Low-dose vaginal misoprostol appears to be a safe and effective procedure for second trimester ToP in women with a history of CD.