In a scarred uterus it is better to avoid misoprostol use although there are studies where misoprostol is used in scarred uterus for induction of abortion in second trimester. If the uterus was unscarred i would prefer 400 mic gm vaginally every six hours with a maximum of 4 doses. However as the fetus is dead and uterus is scarred , I would half the dose i,e 200 mic gm vaginally every six hrs with close monitoring. If ethacridine lactate is available in your area then it will be best for induction ( extra amniotic instillation of 150 ml ethacridine lactate ) in regard to safety and efficacy.
Vaginal misoprostol 200-400/6h is safe , if the previous cesarean scar is transverse, but bilingual route is faster and more effective.
In a scarred uterus it is better to avoid misoprostol use, however, in scarred uterus for induction of abortion in second trimester, lesser dose of Misoprostal i.e half the normal dose of 600 mcg is preferred. The frequency can be every six hours for 4 doses., with close monitoring.
Ganesh Dangal
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