Is misoprostol a safe, effective and acceptable alternative to manual vacuum aspiration for postabortion care? Results from a randomised trial in Burkina Faso, West Africa

Abstract

Objectives Previous research has demonstrated the effectiveness of misoprostol for treatment of incomplete abortion; however, few studies have systematically compared misoprostol's effectiveness with that of standard surgical care. This study documents the effectiveness of a single 600 micrograms dose of oral misoprostol versus manual vacuum aspiration (MVA) for treatment of incomplete abortion in a developing country setting.Design Open-label randomised controlled trial.Setting Two university teaching hospitals in Burkina Faso, West Africa.Population Women of reproductive age presenting with incomplete abortion. Conclusion Six hundred micrograms of oral misoprostol is as safe and acceptable as MVA for the treatment of incomplete abortion. Operations research is needed to ascertain the role of misoprostol within postabortion care programmes worldwide.

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“…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.…”

“…For example, in one study of 447 women in Burkina Faso, the majority of women reported that they were "satisfied" or "very satisfied" with the method they received (misoprostol=96.8%, MVA=86.6%), would choose that method again (misoprostol=94.5%, MVA=86.6%) and would recommend it to a friend (misoprostol=94.5%, MVA=85.2%). 19 Other randomized trials show that women find misoprostol to be more acceptable than MVA for treatment of incomplete abortion. A trial enrolling 300 women in Tanzania found that 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).…”

“…In five randomized controlled trials (n=1484) women reported significantly more "heavy" (more than a period) and "normal" (same as a period) bleeding with misoprostol than following MVA. 9,10,19,20,41 Women in both arms reported similar amounts of "light bleeding" (less than a period) or "spotting" following either MVA or misoprostol treatment.…”