Safety of Vaginal Misoprostol for the Termination of Second Trimester Miscarriage in Women with Previous Uterine Scar in Iraq

Pregnancy termination for a variety of fetal or maternal conditions has been defined as one of the common obstetrical procedures. The presence of an earlier uterine scar has been found as a highly significant risk factor, which needs to be considered before the election of the misoprostol for the termination of pregnancy (TOP) uses. This study aimed to evaluate the safety of vaginal misoprostol in patients who had an earlier uterine scar, and whether its utilization might result in increasing the risks of uterine ruptures. In total, 250 participants were included in the experimental model and divided into two groups including 95 patients in their 2nd trimester of pregnancy with confirmed non-viable fetus and scarred uterus (study group) and 155 pregnant women with no scar in their uterus and missed miscarriage (control group). They received misoprostol tablets in accordance with the Security Hospital Protocol for the TOP. The safety has been specified according to the number of women that had full abortions with no complications. The study group with uterine scar included 95 cases that comprised 38% of the total participants in the study (n=250). Out of 95 cases, 64 (67.3%) patients had successful abortions completely, compared to the control group (the patients with no scar), 111 (71.6%) of whom had complete abortions (P<0.001). However, 44 (28.4%) and 31 (32.6%) patients in the control and study groups, respectively, were in need of surgical evacuations either for the incomplete conception product expulsion or as a result of the excessive per-vaginal bleeding. The use of the misoprostol for the TOP has not been contra-indicated in the females who had Caesarean scars. Moreover, it is efficient in females who do not have scarred uterus.