RANDOMIZED TRIAL OF ORAL MISOPROSTOL COMPARED WITH MANUAL VACUUM ASPIRATION FOR INCOMPLETE ABORTION
Abortion is a sensitive and contentious issue with religious, moral, cultural and political dimensions. It is a public health concern in many parts of the world especially low-resource settings where abortion is highly restricted and self induced abortions are common. Abortion related complications have continued to make substantial contributions to maternal morbidity and mortality in Sub-Saharan Africa. In these countries, access to PAC services especially treatment of incomplete abortion is a priority. Standard post abortion care has involved surgical intervention but can be hard to access in these areas. Oral 600μcg misoprostol provides an alternative to surgical intervention and this could increase access to abortion care in the environments where need for economical non-surgical treatments may be most useful.
To compare the efficacy, safety and acceptability of oral misoprostol with manual vacuum aspiration in the management of first trimester incomplete abortion.
Prospective Comparative study conducted at the University of Ilorin Teaching hospital.
A total of 200 consenting women were randomized in to the study. Out of these women, 100 women received 600μg oral misoprostol and the remaining 100 women were treated with MVA. In the MVA group, 2 women were lost to follow-up and were not included in the final analysis. Efficacy, Safety
and Acceptability of 600μg oral misoprostol were compared with MVA in the eligible women. The results were analysed using SPSS window version 20. The level of significance was tested using t- test, chi-square, Yates correction, Mann Whitney U test. P value of ˂ 0.05 was taken as significant.Results
One hundred and ninety-eight women were included in the final analysis. Both misoprostol and surgical evacuation are highly effective treatment for incomplete abortion (misoprostol=86.5%, MVA = 97% p=0.3). In the 6 hours after treatment, women using misoprostol reported heavier bleeding than women in MVA group (vaginal bleeding mean rank; Misoprostol = 108.74, MVA =92.26, p=0.004) but lower level of abdominal pain than in MVA group(median pain score; misoprostol = 73.28, MVA =127.72, p = <0.001). Rates of acceptability were similarly high among women in the two treatment groups with 93.8% of women in the misoprostol group and 89.8% in the MVA group reported that they would choose the method used for them again. Rates of satisfaction were similarly high among women in the two groups with 92.7% of women in the misoprostol group and 89.8% of women in the MVA group reported that they were satisfied or very satisfied with their method of treatment.
Oral 600μcg of misoprostol is comparable to MVA in terms of efficacy, acceptability, safety in the treatment of incomplete abortion. It is a safe alternative to MVA in the provision of PAC in the management of uncomplicated first trimester incomplete abortion.