1: Shwekerela B, Kalumuna R, Kipingili R, Mashaka N, Westheimer E, Clark W, Winikoff B. Misoprostol for treatment of incomplete abortion at the regional hospital level: results from Tanzania. BJOG. 2007 Nov;114(11):1363-7. Epub 2007 Sep 5. PubMed PMID: 17803714.
To investigate the safety, efficacy, and acceptability of misoprostol versus manual vacuum aspiration (MVA) for treatment of incomplete abortion.
A prospective open-label randomised trial.
Kagera Regional Hospital, Bukoba, Tanzania.
Three hundred women with a clinical diagnosis of incomplete abortion and a uterine size <12 weeks.
A total of 150 women were randomised to either a single dose of 600 micrograms of oral misoprostol or MVA. If abortion was clinically complete at 7-day follow up, the woman was released from the study. If it was still incomplete, the woman was offered the choice of an additional 1-week follow up or immediate MVA. Cases still incomplete after a further week were offered MVA.
MAIN OUTCOME MEASURES
Incidence of successful abortion (success defined as no secondary surgical intervention provided), incidence of adverse effects, patient satisfaction.
Success was very high in both arms (misoprostol: 99%; MVA: 100%; difference not significant). Most adverse effects were higher in the misoprostol arm, although the mean pain score was higher in the MVA arm (3.0 versus 3.5; P < 0.001). More women were very satisfied with misoprostol (75%) than with MVA (55%, P = 0.001), and a higher proportion of women in the misoprostol arm said that they would recommend the treatment to a friend (95% versus 75%, P < 0.001).
Misoprostol is as effective as MVA at treating incomplete abortion at uterine size of <12 weeks. The acceptability of misoprostol appears higher. Given the many practical advantages of misoprostol over MVA in low-resource settings, misoprostol should be more widely available for treatment of incomplete abortion in the developing world.