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Uterine Rupture in an Unscarred Uterus Following Induced Labor with Titrated Oral Misoprostol

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DOI: 10.4236/ojog.2015.514112    1,996 Downloads   2,405 Views  

ABSTRACT

Misoprostol (Cytotec, Pfizer) is a prostaglandin E1 analogue widely used in labor induction. Understanding of potential risks of misoprostol in labor induction is lacking as the drug is used off-label in most countries. A 35-year-old G3P2 woman with post-date pregnancy at 40 + 3 weeks was induced using titrated oral misoprostol. Following delivery, post-partum hemorrhage was noted and, upon discovery of a uterine wall rupture due to congenital weakness of the myometrium, emergency abdominal total hysterectomy was conducted. Following surgery, the patient made a full recovery and was discharged. The main contraindications for misoprostol in labor induction are a scarred uterus or multipara greater than 4. Uterine wall weakness should be considered as a potential contraindication. Extreme vigilance is required in use of misoprostol for labor induction.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Ceurvels, W. and Cheng, S. (2015) Uterine Rupture in an Unscarred Uterus Following Induced Labor with Titrated Oral Misoprostol. Open Journal of Obstetrics and Gynecology, 5, 795-798. doi: 10.4236/ojog.2015.514112.

References

[1] Thaisomboon, A., Russameecharoen, K., Wanitpongpan, P., Phattanachindakun, B. and Changnoi, A. (2012) Comparison of the Efficacy and Safety of Titrated Oral Misoprostol and a Conventional Oral Regimen for Cervical Ripening and Labor Induction. International Journal of Gynecology & Obstetrics, 116, 13-16.
http://dx.doi.org/10.1016/j.ijgo.2011.07.027
[2] McMaster, K., Sanchez-Ramos, L. and Kaunitz, A.M. (2015) Balancing the Efficacy and Safety of Misoprostol: A Meta-Analysis Comparing 25 versus 50 Micrograms of Intravaginal Misoprostol for the Induction of Labour. BJOG, 122, 468-476.
http://dx.doi.org/10.1111/1471-0528.12935
[3] Cheng, S.Y. and Chen, T.C. (2006) Pilot Study of Labor Induction with Titrated Oral Misoprostol. Taiwanese Journal of Obstetrics and Gynecology, 45, 225-229.
http://dx.doi.org/10.1016/S1028-4559(09)60229-1
[4] Cheng, S.Y., Ming, H. and Lee, J.C. (2008) Titrated Oral Compared with Vaginal Misoprostol for Labor Induction: A Randomized Controlled Trial. Obstetrics & Gynecology, 111, 119-125.
http://dx.doi.org/10.1097/01.AOG.0000297313.68644.71
[5] Ho, M., Cheng, S.Y. and Li, T.C. (2010) Titrated Oral Misoprostol Solution Compared with Intravenous Oxytocin for Labor Augmentation: A Randomized Controlled Trial. Obstetrics & Gynecology, 116, 612-618.
http://dx.doi.org/10.1097/AOG.0b013e3181ed36cc
[6] Cheng, S.Y., Hsue, C.S., Hwang, G.H., Chen, W. and Li, T.C. (2010) Comparison of Labor Induction with Titrated Oral Misoprostol Solution between Nulliparous and Multiparous Women. Journal of Obstetrics and Gynaecology Research, 36, 72-78.
http://dx.doi.org/10.1111/j.1447-0756.2009.01118.x
[7] Zieman, M., Fong, S.K., Benowitz, N.L., Banskter, D. and Darney, P.D. (1997) Absorption Kinetics of Misoprostol with Oral or Vaginal Administration. Obstetrics & Gynecology, 90, 88-92.
http://dx.doi.org/10.1016/S0029-7844(97)00111-7
[8] Barrilleaux, P.S., Bofill, J.A., Terrone, D.A., Magann, E.F., May, W.L. and Morrison, J.C. (2002) Cervical Ripening and Induction of Labor with Misoprostol, Dinoprostone Gel, and a Foley Catheter: A Randomized Trial of 3 Techniques. American Journal of Obstetrics & Gynecology, 186, 1124-1129.
http://dx.doi.org/10.1067/mob.2002.123821
[9] Tang, O.S., Gemzell-Danielsson, K. and Ho, P.C. (2007) Misoprostol: Pharmacokinetic Profiles, Effects on the Uterus and Side-Effects. International Journal of Gynecology & Obstetrics, 99, S160-S167.
http://dx.doi.org/10.1016/j.ijgo.2007.09.004
[10] Voigt, F., Goecke, T.W., Najjari, L., Pecks, U., Maass, N. and Rath, W. (2015) Off-Label Use of Misoprostol for Labor Induction in Germany: A National Survey. European Journal of Obstetrics & Gynecology and Reproductive Biology, 187, 85-89.
http://dx.doi.org/10.1016/j.ejogrb.2014.11.026
[11] Hofmeyr, G.J., Gulmezoglu, A.M. and Pileggi, C. (2010) Vaginal Misoprostol for Cervical Ripening and Induction of Labour. Cochrane Database of Systematic Reviews, 2010, Article ID: CD000941.
http://dx.doi.org/10.1002/14651858.cd000941.pub2
[12] Frei, K.A., Duwe, D.G., Bonel, H.M., Durig, P. and Schneider, H. (2005) Posterior Sacculation of the Uterus in a Patient Presenting with Flank Pain at 29 Weeks of Gestation. Obstetrics & Gynecology, 105, 639-641.
http://dx.doi.org/10.1097/01.AOG.0000141695.83741.94
[13] Rajiah, P., Eastwood, K.L., Gunn, M.L. and Dighe, M. (2009) Uterine Diverticulum. Obstetrics & Gynecology, 113, 525-527.
http://dx.doi.org/10.1097/AOG.0b013e31818da0b9
[14] Matsubara, S., Shimada, K., Kuwata, T., Usui, R. and Suzuki, M. (2011) Thin Anterior Uterine Wall with Incomplete Uterine Rupture in a Primigravida Detected by Palpation and Ultrasound: A Case Report. Journal of Medical Case Reports, 5, 14.
http://dx.doi.org/10.1186/1752-1947-5-14

  
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