Is Misoprostol a Safe, Effective and Acceptable Alternative for Treatment of Incomplete Abortion?

J. Blum

Objective: Incomplete abortion continues to contribute disproportionately to maternal morbidity and mortality in much of the developing world, particularly in countries with where restrictive abortion laws mean higher numbers of incomplete, induced abortions requiring further care. Given that incomplete abortion and its sequelae are detrimental to women’s reproductive health, it is critical that every available treatment option be utilized in efforts to reduce morbidity and mortality. Misoprostol offers one such option, and expansion of its use for treatment of incomplete abortion should be aggressively pursued.

Methods: Online research via Pub Med identified 22 published studies on incomplete abortion using misoprostol in at least one of the treatment arms. In addition, data from several trials conducted by Gynuity with results now in press will be presented.

Results: The literature shows that misoprostol, at doses ranging from 400 mcg to 1200 mcg, and administered either vaginally or orally, successfully evacuates the uterus approximately 80 – 95% of the time without need for surgical evacuation. In Uganda, a single dose of 600 mcg oral misoprostol performed slightly better than MVA (96.3% vs. 91.5%). Randomized controlled trials in Burkina Faso, Ghana and Tanzania validated these results. Data from all available published and unpublished trials will be reviewed during this presentation and recommendations for appropriate regimens will be made.

Conclusion: Easy-to-use widely available technologies for treatment of incomplete abortion are vital to women’s health care. Until now, surgical treatment of incomplete abortion has been the gold standard. While surgery certainly provides a highly effective means of uterine evacuation, it is not always a feasible option in low-resource settings with fewer skilled surgical providers and necessary equipment. For some time, providers and policy makers have debated the potential role for misoprostol for treatment of incomplete abortion, but relatively little is known about the feasibility of its use in various settings. This presentation aims to provide the evidence needed to include misoprostol as an alternative for treatment of incomplete abortion worldwide.