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Uterine rupture during induction of labor at term with intravaginal misoprostol
1Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, USA.
Background:
Misoprostol (prostaglandin E1) compares favorably with dinoprostone (prostaglandin E2) 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-microgram 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.