Int J Gynaecol Obstet. 2017 Apr 4. doi: 10.1002/ijgo.12168. [Epub ahead of print]

Misoprostol use for second-trimester termination of pregnancy among women with one or more previous cesarean deliveries

Cuellar Torriente M, Steinberg WJ and Joubert G


Objective: To establish the safety and efficacy of misoprostol for second-trimester termination of pregnancy among women with one or more previous cesarean deliveries.

Methods: In a retrospective study, data were reviewed from women attending a reproductive health clinic in Bloemfontein, South Africa, for second-trimester termination between 2010 and 2013. The study group, comprising women with one or more previous cesareans, was compared with a control group, comprising women with no previous cesarean or uterine scarring. Procedure-specific information was compared, including misoprostol use, termination duration, need for other methods (e.g. oxytocin), placenta delivery, termination outcome, and bleeding.

Results: The study group comprised 268 women: 231 (86.2%) with one and 37 (13.8%) with two previous cesareans. The control group comprised 266 women. Incomplete abortion was recorded in 223 (85.4%) of 261 women in the study group and 213 (80.4%) of 265 in the control group. The number of women with retained placenta was higher in the study than in the control group (158/261 [60.5%] vs 146/265 [55.1%]; P<0.001). Severe bleeding was observed only in the control group (7/266 [2.6%]). No uterine rupture was observed.

Conclusions: Misoprostol was safe for second-trimester termination among women with previous cesareans; however, the efficacy of the local regimen was reduced owing to high placental retention. This article is protected by copyright. All rights reserved.

Comment: As health care providers we are often hesitant to give uterotonics to women with a previous cesarean section, for fear of uterine rupture. This careful retrospective analysis from South Africa shows that even after previous cesarean section, misoprostol can be safely given for medical abortion, although the risk of retained (part of the) placenta was higher. (HMV)