Volume 114, Issue 11 p. 1363-1367

Misoprostol for treatment of incomplete abortion at the regional hospital level: results from Tanzania

B Shwekerela

B Shwekerela

Kagera Regional Hospital, Bukoba, Tanzania

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R Kalumuna

R Kalumuna

Kagera Regional Hospital, Bukoba, Tanzania

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R Kipingili

R Kipingili

Kagera Regional Hospital, Bukoba, Tanzania

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N Mashaka

N Mashaka

Kagera Regional Hospital, Bukoba, Tanzania

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E Westheimer

E Westheimer

Mount Sinai School of Medicine, New York, NY, USA

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W Clark

Corresponding Author

W Clark

Gynuity Health Projects, New York, NY, USA

Dr W Clark, Gynuity Health Projects, 15 East 26th Street, #1617 New York, NY 10010 USA. Email [email protected]Search for more papers by this author
B Winikoff

B Winikoff

Gynuity Health Projects, New York, NY, USA

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First published: 05 September 2007
Citations: 40

Abstract

Objective To investigate the safety, efficacy, and acceptability of misoprostol versus manual vacuum aspiration (MVA) for treatment of incomplete abortion.

Design A prospective open-label randomised trial.

Setting Kagera Regional Hospital, Bukoba, Tanzania.

Sample Three hundred women with a clinical diagnosis of incomplete abortion and a uterine size <12 weeks.

Methods A total of 150 women were randomised to either a single dose of 600 micrograms of oral misoprostol or MVA. If abortion was clinically complete at 7-day follow up, the woman was released from the study. If it was still incomplete, the woman was offered the choice of an additional 1-week follow up or immediate MVA. Cases still incomplete after a further week were offered MVA.

Main outcome measures Incidence of successful abortion (success defined as no secondary surgical intervention provided), incidence of adverse effects, patient satisfaction.

Results Success was very high in both arms (misoprostol: 99%; MVA: 100%; difference not significant). Most adverse effects were higher in the misoprostol arm, although the mean pain score was higher in the MVA arm (3.0 versus 3.5; P < 0.001). More women were very satisfied with misoprostol (75%) than with MVA (55%, P= 0.001), and a higher proportion of women in the misoprostol arm said that they would recommend the treatment to a friend (95% versus 75%, P < 0.001).

Conclusion Misoprostol is as effective as MVA at treating incomplete abortion at uterine size of <12 weeks. The acceptability of misoprostol appears higher. Given the many practical advantages of misoprostol over MVA in low-resource settings, misoprostol should be more widely available for treatment of incomplete abortion in the developing world.