Misoprostol for Treatment of Incomplete Abortion in Sub-Saharan Africa

Dr. Joseph Taylor, Ghana Health Service, Koforidua, Ghana
Co-authors: B. Dao, B. Shwekerela, C. Bique, J. Lankoande, B. Thieba, J. Blum, B. Winikoff

Introduction: Several studies have revealed a single 600 mcg oral dose of misoprostol to be highly effective in treating incomplete abortion. It is commonly thought that this treatment could prove to be as safe and effective as standard surgical treatment. However, this has not been studied sufficiently to confirm the utility and acceptability of misoprostol for treatment of incomplete abortion in low-resource settings.

Materials and Methods: Over 1000 women in Burkina Faso, Ghana, Mozambique, and Tanzania seeking treatment for incomplete abortions were randomized to receive either 600 mcg misoprostol orally or standard surgical treatment (MVA). All women returned for follow-up and evaluation of abortion status at day 15. Success was defined as a complete abortion without recourse to surgical intervention. Women whose expulsions remained incomplete at Day 15 were offered an extended follow-up visit or an immediate surgical evacuation. Once the abortion was complete, all women had exit interviews to gather qualitative information about their experience.

Results: Success rates are above 95% for both the misoprostol and MVA in Ghana and above 99% in Tanzania. More than 90% of women in both groups reported being satisfied with the treatment and that side effects were tolerable. Use of ultrasound was limited (n=4 in Tanzania) as was provision of anesthesia, with use of verbal anesthesia being common for MVA.

Conclusion: 600 mcg of oral misoprostol alone for the treatment of incomplete abortion appears to be as safe and effective as surgical intervention (MVA).