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Case report
Misoprostol-augmented induction of labour for third trimester fetal demise in a patient with prior hysterotomies
  1. Isabel Beshar1,
  2. Karolina Thomson2 and
  3. James Byrne3,4
  1. 1Stanford University School of Medicine, Stanford, California, USA
  2. 2Obstetrics & Gynecology, Santa Clara Valley Medical Center, San Jose, California, USA
  3. 3Maternal Fetal Medicine, Obstetrics and Gynecology, Santa Clara Valley Medical Center, San Jose, California, USA
  4. 4Maternal Fetal Medicine, Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Isabel Beshar; ibeshar{at}stanford.edu

Abstract

A 31-year-old G3P2002 with history of two prior caesarean sections presented with influenza-like illness, requiring intubation secondary to acute respiratory distress syndrome. Investigations revealed intrauterine fetal demise at 30-week gestation.

She soon deteriorated with sepsis and multiple organs impacted. Risks of the gravid uterus impairing cardiopulmonary function appeared greater than risks of delivery, including that of uterine rupture. Vaginal birth after caesarean was achieved with misoprostol and critical care status rapidly improved.

Current guidelines for management of fetal demise in patients with prior hysterotomies are mixed: although the American College of Obstetricians and Gynecologists recommends standard obstetric protocols rather than misoprostol administration for labour augmentation, there is limited published data citing severe maternal morbidity associated with misoprostol use. This case report argues misoprostol-augmented induction of labour can be a reasonable option in a medically complex patient with fetal demise and prior hysterotomies.

  • obstetrics
  • gynaecology and fertility
  • respiratory system
  • pregnancy
  • reproductive medicine
  • adult intensive care

https://doi.org/10.1136/bcr-2020-239872

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    Footnotes

    • Twitter @isabelbeshar

    • Contributors IB initiated the case report project and drafted the paper. KT and JB contributed to additional revisions of the paper. KT and JB were involved in overseeing direct coordination of patient care. IB provided assistance with care.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.