Uterine rupture associated with the use of misoprostol in the gravid patient with a previous cesarean section

Objective: Our purpose is to report our experience with uterine rupture in patients undergoing a trial of labor after previous cesarean delivery in which labor was induced with misoprostol. The literature on the use of misoprostol in the setting of previous cesarean section is reviewed. Study Design...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 1999-06, Vol.180 (6), p.1535-1542
Main Authors: Plaut, Melanie M., Schwartz, Martin L., Lubarsky, Suzanne L.
Format: Article
Language:English
Subjects:
Adult
Cesarean Section
Female
Humans
induction of labor
Labor, Induced
Misoprostol
Misoprostol - adverse effects
Oxytocics - adverse effects
Pregnancy
Risk Factors
Trial of Labor
uterine rupture
Uterine Rupture - epidemiology
vaginal birth after cesarean delivery
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Summary:Objective: Our purpose is to report our experience with uterine rupture in patients undergoing a trial of labor after previous cesarean delivery in which labor was induced with misoprostol. The literature on the use of misoprostol in the setting of previous cesarean section is reviewed. Study Design: This report was based on case reports, a computerized search of medical records, and literature review. Results: Uterine rupture occurred in 5 of 89 patients with previous cesarean delivery who had labor induced with misoprostol. The uterine rupture rate for patients attempting vaginal birth after cesarean section was significantly higher in those who received misoprostol, 5.6%, than in those who did not, 0.2% (1/423, P = .0001). Review of the literature reveals insufficient data to support the use of misoprostol in the patient with a previous cesarean delivery. Conclusion: Misoprostol may increase the risk of uterine rupture in the patient with a scarred uterus. Carefully controlled studies of the risks and benefits of misoprostol are necessary before its widespread use in this setting. (Am J Obstet Gynecol 1999;180:1535-42.)
ISSN:0002-9378
DOI:10.1016/S0002-9378(99)70049-9