Abstract
BackgroundIn low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC) services, especially treatment of incomplete terminations, is a priority. Standard post-abortion care has involved surgical intervention but can be hard to access in these areas. Misoprostol provides an alternative to surgical intervention that could increase access to abortion care. We sought to gather additional evidence regarding the efficacy of 400 mcg of sublingual misoprostol vs. standard surgical care for treatment of incomplete abortion in the environments where need for economical non-surgical treatments may be most useful.MethodsA total of 860 women received either sublingual misoprostol or standard surgical care for treatment of incomplete abortion in a multi-site randomized trial. Women with confirmed incomplete abortion, defined as past or present history of vaginal bleeding during pregnancy and an open cervical os, were eligible to participate. Participants returned for follow-up one week later to confirm clinical status. If abortion was incomplete at that time, women were offered an additional follow-up visit or immediate surgical evacuation.ResultsBoth misoprostol and surgical evacuation are highly effective treatments for incomplete abortion (misoprostol: 94.4%, surgical: 100.0%). Misoprostol treatment resulted in a somewhat lower chance of success than standard surgical practice (RR = 0.90; 95% CI: 0.89-0.92). Both tolerability of side effects and women’s satisfaction were similar in the two study arms.ConclusionMisoprostol, much easier to provide than surgery in low-resource environments, can be used safely, successfully, and satisfactorily for treatment of incomplete abortion. Focus should shift to program implementation, including task-shifting the provision of post-abortion care to mid- and low- level providers, training and assurance of drug availability.Trial registrationThis study has been registered at clinicaltrials.gov as NCT00466999 and NCT01539408
Highlights
In low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC) services, especially treatment of incomplete terminations, is a priority
Efficacy with the misoprostol was slightly lower: 94.4% of the women who received misoprostol and 100% of the women who received surgical intervention had successful evacuations (RR = 0.90; 95% CI: 0.88-0.92) (Table 2)
There was variation in success with misoprostol by site, with completion rates ranging from 88.7% in Niger to 97.6% in Burkina Faso, where providers had previous experience using misoprostol for treatment of incomplete abortion
Summary
In low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC) services, especially treatment of incomplete terminations, is a priority. Complications of pregnancy failure (spontaneous or induced abortion) are a major cause of maternal morbidity and mortality, in low-resource settings where abortion is highly restricted and self-induced abortions are common [1]. In these countries access to post-abortion care (PAC) services, especially treatment of incomplete terminations, is a priority. It will contribute to task-shifting efforts by enabling lower level providers to manage post-abortion care This could be helpful in places with limited human resources
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
