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

William Ceurvels; Shi-Yann Cheng

doi:10.4236/ojog.2015.514112

Home > Journals > Medicine & Healthcare > OJOG

Open Journal of Obstetrics and Gynecolog... > Vol.5 No.14, December 2015

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

¹College of Chinese Medicine, China Medical University, Taiwan.
²School of Medicine, China Medical University, Taiwan.
³Department of Obstetrics and Gynecology, China Medical University Beigang Hospital, Taiwan.

DOI: 10.4236/ojog.2015.514112 PDF HTML XML 2,229 Downloads 2,724 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.

Keywords

Labor Induction, Misoprostol, Post-Partum Hemorrhage, Uterine Rupture

Share and Cite:

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.

Conflicts of Interest

The authors declare no conflicts of interest.

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