Interruption of pregnancy with previous two to three caesarean sections with misoprostol
Objective: To establish the success rate and safety of vaginal birth with misoprostol for 16 to 30 weeks of pregnancy in women with previous two to three caesarean sections.
Methodology: The prospective observational study was carried out at Obstetrics and Gynaecology department of Pak Emirates Military Hospital Rawalpindi, from 1st Oct 2017 to 30th Sept 2018. 304 patients with a pregnancy between 16 to 30 weeks, with two to three caesarean sections. Indications for interruption/termination of pregnancy included major foetal abnormalities, early severe growth restriction of the foetus, foetal demise, foetal β-thalassemia, preterm pre-labour rupture of membranes, early severe pre-eclampsia and other maternal diseases. The patients with contraindications to vaginal birth like low lying placentae, transverse lie, huge foetal tumours, and hydrops fetalis were excluded from the study. First trimester pregnancy terminations were also excluded. Labour was induced with oral misoprostol 200µg 6 hourly in pregnancies between 16 to 20 weeks and 200µg 12 hourly from 20 to 30 weeks, followed by cervical catheter in selected cases.
Results: Misoprostol induction of labour with two to three previous caesarean sections resulted in vaginal delivery in 94.07% of the cases and repeat scar was avoided in further 2.3%. Uterine scar rupture was encountered in 0.6% of the patients and minor complications were observed in 6.8% in total.
Conclusion: The efficacy and safety of properly chosen dose of misoprostol via oral route in patients with previous caesarean sections was established. Its use should be encouraged in tertiary care consultant led hospitals
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