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.