Midtrimester abortion using vaginal misoprostol for women with three or more prior cesarean deliveries

To evaluate the safety and efficacy of vaginal misoprostol for second-trimester abortion in women with 3 or more prior cesarean deliveries.

This study was conducted with 138 women who needed pregnancy termination between 13 and 26 gestational weeks, 31 with 3 or more previous cesarean deliveries and 107 with no uterine scars (the controls). Misoprostol was inserted in the vagina every 6 hours until regular contractions or products of conception appeared, a 200-microg tablet for the first 24 hours and 2 tablets thereafter. The outcomes assessed were successful vaginal abortion, hemorrhage requiring blood transfusion, incomplete abortion, and uterine rupture.

A vaginal abortion occurred in 28 women (90.3%) in the study group and 107 (100%) in the control group (P=0.01). There were no significant differences in the prevalence of the other assessed outcomes.

Vaginal misoprostol appears to be safe and acceptably effective for second-trimester pregnancy termination in women with 3 or more previous cesarean deliveries.