Misoprostol-induced termination of second-trimester pregnancy in women with a history of cesarean section: a retrospective analysis of 56 cases.

OBJECTIVE To assess the effectivity and safety of misoprostol induced termination of pregnancy in the second trimester in women with a history of previous caesarean section. MATERIALS AND METHODS Retrospective analysis of case records from the obstetrics and gynecology department of a tertiary care center between January 2009 and February 2012 was performed. Data derived from 219 women, who underwent a second trimester termination of pregnancy, was analyzed in terms of demographics, clinical findings, laboratory and procedural data. The study group consisted of 56 women with a previous caesarean section and the control group was composed of 163 women without such a history. Termination of pregnancies was conducted by administration of misoprostol at doses of 50-600 mcg intravaginally or by surgical evacuation in cases of failure of medical measures. RESULTS There was no statistically significant difference between two groups in terms of demographics such as age, menarche, number of pregnancies or live births, smoking habit and co-morbidities. Necessity for blood transfusion (p = 0.05) and additional procedure for abortion (p = 0.056) were found to be similar in both groups. However laparotomy (p = 0.004), uterine rupture (p = 0.016), hysterotomy (p < 0.001) were performed more frequently in the study group; while abortion was more likely to occur within 24 hours in the control group (p = 0.031). CONCLUSION Medical abortion must be carefully used for the termination of second trimester pregnancies in women with a history of CS. Increased possibility of uterine rupture and requirement of interventions such as laparotomy or hysterotomy is more likely in these patients.