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Open Access 01-12-2012 | Research article

Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries

Authors: Tara Shochet, Ayisha Diop, Alioune Gaye, Madi Nayama, Aissata Bal Sall, Fawole Bukola, Thieba Blandine, Okunlola Michael Abiola, Blami Dao, Ogunbode Olayinka, Beverly Winikoff

Published in: BMC Pregnancy and Childbirth | Issue 1/2012

Abstract

Background

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. 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.

Methods

A 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.

Results

Both 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.

Conclusion

Misoprostol, 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 registration

This study has been registered at clinicaltrials.gov as NCT00466999 and NCT01539408

Available only for authorised users

World Health Organization (WHO): Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. 2011, Geneva: WHO, 6

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Shwekerela B, Kalumuna R, Kipingili R, Mashaka N, Westheimer E, Clark W, Winikoff B: Misoprostol for treatment of incomplete abortion at the regional hospital level: Results from Tanzania. BJOG. 2007, 114 (11): 1363-1367. 10.1111/j.1471-0528.2007.01469.x.CrossRefPubMed

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/12/127/prepub

Title: Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries
Authors: Tara Shochet
Ayisha Diop
Alioune Gaye
Madi Nayama
Aissata Bal Sall
Fawole Bukola
Thieba Blandine
Okunlola Michael Abiola
Blami Dao
Ogunbode Olayinka
Beverly Winikoff
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2012
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/1471-2393-12-127

At a glance: The STEP trials

Springer Medicine

Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries

Abstract

Background

Methods

Results

Conclusion

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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