DISRUPTION OF PRIOR UTERINE INCISION FOLLOWING MISOPROSTOL FOR LABOR INDUCTION IN WOMEN WITH PREVIOUS CESAREAN DELIVERY

Background: 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 beca use of safety concerns. Cases: Disruption of the prior uterine incisio n was found in two of 17 misoprostol-treated women. The first woman un derwent repeat cesarean delivery at 42 weeks because of fetal tachycar dia and repetitive late decelerations. A 10-cm vertical rent in the an terior 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 rup ture. An 8-cm longitudinal uterine defect was found. Conclusion: When misoprostol is used in women with previous cesareans, there is a high frequency of disruption of prior uterine incisions. (C) 1998 by The Am erican College of Obstetricians and Gynecologists.