Evaluation of low-dose vaginal misoprostol in pregnancy terminations below 34 weeks of gestation: Time to change the dose?

Objective: To evaluate of the effectiveness of low-dose (LD) vaginal misoprostol administration, where dose adjustment was made by taking into account the gestational week and cesarean section (C/S) history in termination of pregnacy (ToP). Design: Retrospective observational cohort study. Setting: A single tertiary center Population: 563 patients who opted ToP under 34 weeks of gestation. Methods: Outcomes were ascertained by health record review and compared between subgroups according to gestational weeks and previous C/S history. Main Outcome Measures: Total misoprostol administration time, total labor time, total misoprostol dose, >1 ToP method, uterin rupture, uterine atony Results: 63% (357) of 563 cases with pregnancy termination were below the 24th gestational week (Gx). The remaining 206 cases (Gy) (37%) were between 24 and 34 weeks of gestation. The rate of C/S history was statistically significantly higher in Gx (p=0.030). While a single termination method below 24 weeks was sufficient in 94% of cases, this rate remained at 86% in Gy (p=0.002). There was no difference in the complication rate between the groups according to the gestational week or the presence of a prior C/S (p>0.05). Concusions: The present regimen is an effective method with low maternal morbidity and high success without increasing the total treatment time. Especially in patients with a history of C/S where the ‘experience of ToP with misoprostol’ have relatively high risk , and in all ToPs below 34 weeks, achieving a high birth rate without increasing the uterine rupture rate suggests that it is a safe approach.