Uterine Rupture Associated With Misoprostol Use in an Unscarred Uterus: A Case Report

Objective: Uterine rupture associated with intravaginally administered misoprostol has been extensively reported in the medical literature. Most cases occur in patients with a scarred uterus or previous uterine surgery; however, there have only been a handful of reports on rupture in an unscarred uterus. Case Report(s): In this report, we present a case of uterine rupture in a 32-year-old multiparous woman after the trial of labor during which 100μg misoprostol was placed in the posterior vagina fornix. To our knowledge, there have been very few reports in the literature describing misoprostol at a high dosage such as ours for the purpose of labor induction, which probably ultimately contributes to uterine rupture as in our patient. An emergent cesarean section was performed due to fetal distress, and fortunately both mother and fetus recovered well with no complications. Conclusion(s): As depicted in this report, there is growing concern about the association of misoprostol with uterine rupture. The standard dosage of intravaginal misoprostol has not been determined, but there is speculation that an initial high dose of misoprostol should be avoided in favor of a low dose. The risk of uterine rupture is well documented in the literature, and physicians should exercise extreme caution when using misoprostol for cervical ripening at higher doses, even in an unscarred uterus.