Introduction

In the UK, current guidelines recommend inducing labour with mifepristone followed by a course of misoprostol for patients who have experienced an intrauterine death and those undergoing a termination of pregnancy for medical reason after 16 weeks. For patients with a previous caesarean section scar, the dose of misoprostol is reduced due to the risk of scar rupture.  There is little evidence base to guide what treatment is appropriate if first line medical management has been unsuccessful.  Options commonly utilised are repeated courses of misoprostol or surgery.  Surgical options include hysterotomy or dilatation and evacuation.  Both options carry increased risk of maternal morbidity and many clinicians will have little or no experience in performing dilatation and evacuation.  We present a case series using intramuscular carboprost (PGF2α) when first line treatment has been unsuccessful.