INTRODUCTION
Prenatal sonography makes it possible to diagnose structural anomalies,
aneuploidies or genetic syndromes incompatible with life starting from
early weeks of gestation.1 The termination of
pregnancy (ToP) option has been offered to the families according to
these findings and this limit of gestational week varies from country to
country. Among the few methods recommended for ToP so far, misoprostol
is still the cheapest, most effective pharmaceutical with a known
side-effect profile.2-4 Misoprostol stands out because
mifepristone is not available in some countries and oxytocin is not a
good option for inappropriate cervix.2
A guideline was published by the International Federation of Gynecology
and Obstetrics (FIGO) in 2017 for use in pregnancy
terminations.5 In this guideline, it is recommended to
use misoprostol doses at <13, 13-26, >26 weeks of
gestation at varying doses and intervals. However, the recommended
vaginal doses of misoprostol in this guideline are relatively high, and
countries are recommended to use their own local protocols in the
presence in patients with a history of cesarean section. The most
important reason for this is the increased risk of uterine rupture,
placental retention and postpartum bleeding associated with them in the
presence of a history of cesarean section.3, 6-10Therefore, with increasing cesarean rates, the management of pregnancy
terminations is becoming an important problem.2, 11From past to present, many studies using misoprostol for pregnancy
termination in patients with previous cesarean section (C/S) have been
presented.3, 6-12 The misoprostol dose, route, dose
ranges and gestational week limits used in these studies vary. This
situation prevents reaching a certain standardization in management in
patients planned for ToP, whether or not they have a history of C/S.
Moreover, not only the history of C/S, but also the number of prior C/S
is an important factor that can affect these
results.10-12 Therefore, there is a need for
standardized protocols that can be used safely at all gestational weeks
regardless of cesarean section history, and that are effective and have
a low side-effect profile.
In this study, the efficacy of low-dose vaginal misoprostol
administration in which dose adjustment was made according to the
gestational week and previous cesarean section history in pregnancy
terminations below 34 weeks of gestation was investigated.