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Is misoprostol a suitable alternative to the surgical evacuation of incomplete abortion in rural South-Eastern Nigeria?
Abstract
Background: Research has demonstrated the effectiveness of misoprostol for treatment of incomplete abortion. However, few studies have focused on the feasibility of treating incomplete abortion with misoprostol at the rural clinic level in sub-Saharan Africa.
Objective: To determine the effectiveness, safety and acceptability of misoprostol as an alternative to the surgical treatment of incomplete abortion at a rural clinic.
Design: Open-label randomised controlled trial.
Setting: A private clinic in Ekeakpara community, Osisioma Ngwa Local Government Area, Abia State, Nigeria.
Subjects: Women of reproductive age presenting with incomplete abortion.
Results: Regardless of treatment allocation, nearly all women had a complete uterine evacuation with either oral misoprostol or manual vacuum aspiration (misoprostol: 98.8%, MVA: 100%, P = 0.99). Misoprostol users were more likely to report that they were ‘very satisfied’ with the method (75.6% versus 45%, P<0.001). In the 72 hours after treatment, women using misoprostol reported heavier bleeding but lower levels of pain than those treated with manual vacuum aspiration. Women in the misoprostol
group were more likely to choose that treatment again (96.9 versus 55.6%; P<0.001) and would recommend it to a friend.
Conclusion: For treatment of first-trimester uncomplicated incomplete abortion at a rural facility, both MVA and 600 ìg oral misoprostol are safe, effective, and acceptable treatments. Depending on availability of each method and the desires of individual women, either option may be presented to women for the treatment of incomplete abortion.
Objective: To determine the effectiveness, safety and acceptability of misoprostol as an alternative to the surgical treatment of incomplete abortion at a rural clinic.
Design: Open-label randomised controlled trial.
Setting: A private clinic in Ekeakpara community, Osisioma Ngwa Local Government Area, Abia State, Nigeria.
Subjects: Women of reproductive age presenting with incomplete abortion.
Results: Regardless of treatment allocation, nearly all women had a complete uterine evacuation with either oral misoprostol or manual vacuum aspiration (misoprostol: 98.8%, MVA: 100%, P = 0.99). Misoprostol users were more likely to report that they were ‘very satisfied’ with the method (75.6% versus 45%, P<0.001). In the 72 hours after treatment, women using misoprostol reported heavier bleeding but lower levels of pain than those treated with manual vacuum aspiration. Women in the misoprostol
group were more likely to choose that treatment again (96.9 versus 55.6%; P<0.001) and would recommend it to a friend.
Conclusion: For treatment of first-trimester uncomplicated incomplete abortion at a rural facility, both MVA and 600 ìg oral misoprostol are safe, effective, and acceptable treatments. Depending on availability of each method and the desires of individual women, either option may be presented to women for the treatment of incomplete abortion.
