UTERINE RUPTURE ASSOCIATED WITH MISOPROSTOL LABOR INDUCTION IN WOMEN WITH PREVIOUS CESAREAN DELIVERY. Perinatoloji Dergisi 2002;10(3):3-3 DOI:
- SSK Bakırköy Maternity and Children Hospital Department of Perinatology İstanbul
Objective: To review our experience with uterine rupture in patients undergoing a trial of labor with a history of previous cesarean delivery in which labor was induced with misoprostol.
Methods: A retrospective chart review was used to select patients who underwent induction of labor with misoprostol during the period from February 1999 to June 2002. Women with a history of cesarean delivery were retrospectively compared with those without uterine scarring. Criteria for patients receiving misoprostol included intrauterine fetal death and a Bishop score <6. Unexplained vaginal bleeding, history of prior classic cesarean delivery or major uterine surgery, and fetal malpresentation were the exclusion criteria. Fifty micrograms of misoprostol was placed in the posterior vaginal fornix. If after 4 hours the patient stili met the inclusion criteria, second dose of vaginal misoprostol was given. An oral dose of 100 ug was repeated every four hours for a total of six doses.
Results: Uterine rupture occured in 4 of 41 patients with previous cesarean delivery who had labor induced with misoprostol. The rate of uterine rupture (9.7%) was significantly higher in patients with a previous cesarean delivery (p< .001). No uterine rupture occured in patients without uterine scarring. Women with a history of cesarean delivery were more likely to have oxytocin augmentation than those without uterine scarring (41% vs 20%; p= .037).
Conclusion: Misoprostol induction of labor increases the risk of uterine rupture in women with a history of cesarean delivery.