Comparison of misoprostol and manual vacuum aspiration for the treatment of incomplete abortion

Abstract

Although oral misoprostol was less effective than MVA in this study, it was more acceptable to women. Misoprostol is well-suited for use in low-resource settings, and should be promoted as an option for the treatment of incomplete abortion.

The medical management of missed miscarriage: outcomes from a prospective, single‐centre, Australian cohort

“…Studies show that women prefer it to invasive surgery, and show that women with incomplete abortions choose medical treatment with misoprostol over surgery for that reason. [8][9][10] For these reasons, this method is slowly gaining attention as an easy to use, feasible, low-cost means of uterine evacuation that could revolutionize treatment for this condition.…”

“…This dose has successfully evacuated the uterus in over 1000 women in over a half a dozen trials worldwide. 9,10,19,20,11 Recently completed trials testing 400 mcg sublingual misoprostol compared to 600 mcg oral misoprostol found that that the 400 micrograms sublingual dose is as effective as 600 micrograms oral misoprostol when used for treatment of incomplete abortion. 22 Although the data in support of the 400 microgram sublingual misoprostol dose are less extensive, it may be shown in the future to be the optimal dose and route of administration for this indication.…”

“…5,9,10,12,14,19,20,[25][26][27][28][29][30][31][32][33][34][35][36][37][38]41 (Table 1) The success rate reported in trials is closely related to the length of time after treatment at which the uterus is reassessed by ultrasound exam. 16 Early studies on the use misoprostol for incomplete abortion tested a range of doses (400 mcg to 1200 mcg) and routes (oral, vaginal, intrauterine, etc.…”

“…In these trials, a 600 mcg oral dose was tested in more than 1000 women. 9,10,19,20 In most cases, complete uterine evacuation was ascertained using clinical criteria alone. Only one of four published studies (in Burkina Faso) testing this regimen required that women have their abortion status validated by ultrasound.…”

“…10 This sentiment was echoed in another trial of 270 women in Mozambique; those who were allocated to misoprostol were significantly more likely to be "very satisfied" with the treatment and willing to choose the method again (misoprostol= 86.5%, MVA= 36.6%, p<0.001). 9 A Hong Kong trial assessing psychological impact and client satisfaction with medical versus surgical treatment for spontaneous abortion found no difference in reported rate of satisfaction among women treated with misoprostol or surgery. 39 Women for whom misoprostol failed and therefore surgical back-up was needed were generally less satisfied than those for whom the given method succeeded.…”