Uterine rupture and dehiscence associated with intravaginal misoprostol cervical ripening

OBJECTIVE: To evaluate if the prostaglandin E-1 analogue misoprostol, when used as an agent for cervical ripening, is associated with uterine rupture. STUDY DESIGN: We performed a two-year retrospective chart review to determi ne the incidence of uterine rupture in patients with a previous cesarean de livery undergoing cervical ripening or the induction of labor. RESULTS: Uterine dehiscence occurred in 1 and uterine rupture occurred in 3 of 48 women with a prior cesarean delivery treated with 50 mug noses of in travaginal misoprostol for cervical ripening. Uterine rupture was found in 1 of 89 women who had air oxytocin infusion for induction of labor and none of the 24 patients who received intravaginal prostaglandin E-2 placed for cervical ripening. CONCLUSION: Intravaginal misoprostol appears to be associated with an incre ased incidence of uterine rupture when used in patients undergoing a trial of labor after cesarean.