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Management of women with one or more previous caesarean sections requiring induction of labour following midtrimester termination of pregnancy or intrauterine death
  1. EJ Glanville,
  2. RR Patel
  1. University Hospitals Bristol, Bristol, UK

Abstract

Objectives There are data to document the increased risks of prostaglandin induced labour (IOL) following previous Caesarean section (CS) at term. Evidence concerning IOL following CS in the midtrimester, is particularly lacking. Women with previous CS requiring midtrimester IOL for termination of pregnancy (TOP) or intrauterine death (IUD) need good information regarding the risks of the procedure.

Methods Retrospective review of all cases of IOL for TOP from 18 to 28, or IUD from 20 to 28 weeks' gestation over 3 years (2007–2009) in a tertiary unit in Bristol, UK. Cases were identified using mortuary records, and reviewed individually using the local maternity database and case notes.

Results There were a total of 50 cases of midtrimester TOP or IUD requiring IOL with a misoprostol based regimen. 7/50 cases had at least one previous CS, all of whom underwent IOL. Of 3/50 cases with two previous CS, vaginal delivery was achieved in two cases and one required uterine repair, due to asymptomatic uterine rupture, suspected after minimal progress. Additionally, 4/50 requiring IOL had one previous CS. All four had IOL and achieved vaginal delivery.

Conclusion IOL in the midtrimester in women with one or more previous CS is largely successful, but carries the risk of serious morbidity. The numbers of cases are small, even in a large unit. With the rising CS rate, good evidence is needed to counsel these women (particularly for those with two previous CS) regarding the safety of IOL in the midtrimester. Clinicians should recognise that rupture may be asymptomatic.

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