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A randomized controlled trial of 400‐μg sublingual misoprostol versus manual vacuum aspiration for the treatment of incomplete abortion in two Egyptian hospitals
Author(s) -
Dabash Rasha,
Ramadan Mohamed Cherine,
Darwish Emad,
Hassanein Nevine,
Blum Jennifer,
Winikoff Beverly
Publication year - 2010
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2010.06.021
Subject(s) - misoprostol , vacuum aspiration , medicine , incomplete abortion , abortion , obstetrics , relative risk , randomized controlled trial , confidence interval , adverse effect , gynecology , pregnancy , surgery , population , family planning , research methodology , genetics , environmental health , biology
Objective To compare the safety, efficacy, and acceptability of 400‐μg sublingual misoprostol with that of manual vacuum aspiration (MVA) in 2 Egyptian hospitals. Methods Participating women were randomized to either MVA or misoprostol treatment for incomplete abortion. The primary outcome, complete uterine evacuation, was determined 1 week later, as were adverse effects, change in hemoglobin, acceptability, and satisfaction. Results Complete uterine evacuation was achieved in 98.3% of women who received misoprostol and 99.7% who underwent MVA (relative risk [RR] 0.99; 95% confidence interval [CI], 0.97–1.00). A decrease in hemoglobin of 2 g/dL or more was comparably rare in the 2 groups (0.3% misoprostol vs 0.9% MVA; RR 0.34 [95% CI, 0.04–3.21]). Mean change in hemoglobin was also clinically similar (–0.5 g/dL misoprostol vs –0.4 g/dL MVA; P < 0.01). Heavy bleeding was rare (2.4% misoprostol vs 1.6% MVA; RR 1.55 [95% CI, 0.51–4.68]) following treatment. Nearly all women (96.8% misoprostol vs 98.3% MVA) were satisfied with their treatment but those who received misoprostol were significantly more likely to prefer that method in the future (81.9% vs 62.8%; RR 1.30 [95% CI, 1.19–1.43]). Conclusion The high efficacy, safety, and acceptability of 400‐μg sublingual misoprostol indicate that it is analogous to surgery as a first‐line treatment for incomplete abortion. Misoprostol might improve post‐abortion care when resources are limited and surgical treatment is unavailable.