Study Finds Misoprostol Safe for Some VBAC Cases.

CHICAGO -- Despite published reports and committee opinions to the contrary, careful misoprostol use in select [patients undergoing vaginal birth after cesarean section is safe, according to the author of one of the largest studies to date to examine this issue.

"If you use a small dose [of misoprostol], under controlled circumstances where there is very close monitoring, you can have, good success," said Dr. Victor Nwachuku, who presented his findings in poster form at the annual meeting of the American College of Obstetricians and Gynecologists.

That conclusion stands in stark contrast to ACOG's position on the matter. "Misoprostol is contraindicated in VBAC," said Dr. Stanley Zinberg, vice president of practice activities for the college. "All our committee opinions say this should not be used in women with a previous cesarean, period. There's no question about that."

Misoprostol was approved by the Food and Drug Administration in 1988 solely for preventing and treating peptic ulcers. It is frequently used off label for cervical ripening or labor induction in pregnant women.

Concerns about using misoprostol in VBAC patients stems from reports in the literature linking it to complications such as tachysystole, hyperstimulation, and uterine rupture. "This is a drug that can be associated with uterine rupture, and the patient most at risk for uterine rupture is someone with a previous cesarean," Dr. Zinberg cautioned.

But Dr. Nwachuku, an ob.gyn. in private practice in Silver City, N.M., said those risks can be minimized.

Dr. Nwachuku's retrospective study, which he conducted while with Albert Einstein Medical Center in Philadelphia, compared three groups of VBAC patients: 100 received misoprostol and oxytocin, 167 received oxytocin alone, and 115 went into spontaneous ...