Presentation at the Global Maternal Newborn Health Conference, October 19, 2015
Background: Incomplete abortion is a global maternal health challenge and its complications contribute significantly to maternal morbidity and mortality in Nigeria and other developing countries. Because of the constraints associated with accessing post abortion care services with manual vacuum aspirator (MVA) including need for theatre space, sterile instruments, and skilled providers; there is need to explore other effective, accessible, and acceptable non-surgical options. This study compared the effectiveness of single dose sublingual misoprostol to manual vacuum aspiration in the treatment of incomplete abortion in Enugu, South-east Nigeria.
Methodology: Consenting eligible women presenting with 1st trimester incomplete abortion at the gynaecological emergency wards of two specialist hospitals in Enugu, Nigeria, were randomized to receive either single dose sublingual misoprostol 400 microgram (study group) or surgical evacuation with MVA (control group). Participants were followed up for 1 week after which complete evacuation incidence, side effects, and participants’ satisfaction were assessed. Analysis was per protocol at 95% confidence level, using SPSS version 20 for windows.
Results: Basic characteristics were comparable between the two groups. Incidence of complete evacuation after one week of follow-up was 86.3% (88/102) for the misoprostol group and 100.0% (101/101) for the MVA group (P < 0.001). Ninety (60.8%) and 58 (39.2%) women reported side effects in the misoprostol and control groups respectively (p < 0.001). Using visual analogues scale, participants in the misoprostol group were significantly more satisfied with their treatment than the MVA group ( 86.7 mm ± 14.11 mm vs 81.4 mm ±11.10; p < 0.001).
Conclusion: Single dose sublingual misoprostol (400 microgram) achieved complete evacuation in a majority of women with 1st trimester incomplete abortion in Enugu, Nigeria but, it is less effective than surgical evacuation with MVA. Its use in well selected cases of post-abortion care is therefore recommended in under-resourced settings.