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Vaginal Misoprostol Safety and Efficacy in Second Trimester Pregnancy Termination in Women with a Previous Cesarean Section

Background: In patients who have already undergone a cesarean section, there is increasing use of medications to terminate the pregnancy due to fetal death or fetal anomalies. Objectives: To study the safety and efficacy of pregnancy termination using vaginal misoprostol in women undergone a single lower segment cesarean section. Patients and methods: This clinical trial study included 100 women (attending the Department of Gynecology and Obstetrics, Benha University hospitals) with one previous lower segment cesarean section who were advised to terminate their pregnancy (after 13-26 weeks) due to intrauterine fetal death or fetal structural anomalies. They were divided into two equal groups Group I (cases) who had uterine scars, while Group II (control) without scars. History, clinical examination, and ultrasound imaging were performed on all patients. There were 72 hours in which the patient was given misoprostol every four hours via the vaginal route. Results: It was found that the induction-to-abortion period was much shorter in the control group than in the cases group despite no significant differences in age, parity, gestational age, or doses required to induce abortion between the two groups. There were non-significant differences between patient group I with uterine scar and control group II without uterine scar regarding doses needed, except for 1-4 doses and 9-12 doses which exhibited significant differences. Conclusion: In women who have had a previous cesarean section, the vaginal route of misoprostol in a dose of 50 µg /4 hours is safe and successful for inducing a second-trimester abortion.