Disruption of Prior Uterine Incision following Misoprostol for Labor Induction in Women with Previous Cesarean Delivery

TLDR

Misoprostol use in women with prior cesareans is associated with a high frequency of disruption of previous uterine incisions. The study compared misoprostol to oxytocin for labor induction in women with prior cesareans in a randomized trial. The randomized trial was halted early due to safety concerns, with two of 17 misoprostol‑treated women experiencing uterine incision disruption. The trial was stopped early because two of 17 misoprostol‑treated women suffered uterine ruptures—a 10‑cm vertical rent and an 8‑cm longitudinal defect—leading to emergency cesarean deliveries.

Abstract

Although induction of labor in women with prior cesareans is controversial, we compared misoprostol to oxytocin in such women in a randomized trial. The investigation was terminated prematurely because of safety concerns.Disruption of the prior uterine incision was found in two of 17 misoprostol-treated women. The first woman underwent repeat cesarean delivery at 42 weeks because of fetal tachycardia and repetitive late decelerations. A 10-cm vertical rent in the anterior myometrium was discovered. The second woman underwent induction for fetal growth restriction. Loss of fetal heart tones and abnormal abdominal contour prompted emergent cesarean for suspected uterine rupture. An 8-cm longitudinal uterine defect was found.When misoprostol is used in women with previous cesareans, there is a high frequency of disruption of prior uterine incisions.