Misoprostol for Second and Third-Trimester Labor Induction In Women with Previous Cesarean Delivery

Objective: To evaluate the use of misoprostol in second and third trimester labor induction in women with previous cesarean delivery. Methods: Women with previous cesarean delivery and normal controls seen for second and third trimester labor induction were randomly assigned to receive either misoprostol vaginally 50 μg or 100 μg every 6 hours until active phase of labor achieved. Primary outcome measures were uterine rupture, induction-delivey interval, vaginal delivery at 24 hours. Statistical analysis was performed with the ANOVA for continous variables and the chi square and Fisher exact test for categorical variables. P<0.05 was considered significant. Results: Three hundred and twenty three were randomised, with 67 with prior cesarean section and 256 controls. The two groups were comparable with respect to gestational age, birth weight, preinduction cervical length and total misoprostol dose. The mean induction-delivery interval was significantly longer for the prior cesarean group (61.9 ± 7.71 hours vs 26.3 ± 1.45 hours, p<0.001). Significantly more women in the control group were delivered within 24 hours (p<0.001). No uterine rupture was detected in the previous cesarean group. Conclusion: In second and third trimester labor induction, the use of misoprostol in women with previous cesarean delivery was not associated with an excess of complications, side effects and cesarean delivery rates.