Use of Misoprostol to Treat Incomplete Abortion Should Be Limited To the First 12 Weeks of Pregnancy

abortion with misoprostol differed substantially by gestational age: Ninety-nine percent of pregnancies of 12 or fewer weeks did not require manual vacuum aspiration after miso-prostol, compared with 26% of pregnancies of 13–14 weeks and 28% of pregnancies of 15–18 weeks. These successful cases included those in which ultrasound at the 15-day follow up revealed residue not requiring intervention (4% of women pregnant 12 or fewer weeks, 10% of those pregnant 13–14 weeks and 14% of those pregnant 15–18 weeks). Eight percent of women with pregnancies of 12 or fewer weeks and 3% of those with pregnancies of 13–14 weeks were lost to follow-up and presumed to have had no complications; no woman with a pregnancy of more than 14 weeks failed to return for follow-up. Following misoprostol administration, 27% of women reported severe pain, 18% experienced chills, 11% felt hyperthermic and 5% had heavy bleeding. The proportion of women reporting adverse effects was lower among those 12 or fewer weeks pregnant than among those with more advanced pregnancies. For example, 8% of women with pregnancies of up to 12 weeks' gestation experienced severe pain, compared with 93–100% of women with pregnancies of longer durations. Heavy bleeding occurred only among women with pregnancies of more than 12 weeks; 7% of women with pregnancies of 13–14 weeks and 44% of women with pregnancies of 15–18 weeks reported this outcome. In defending the assumption that the women lost to follow-up were likely not to have required surgical evacuation, the researchers noted that the socioeconomic status of these women indicates that they probably would have sought free care at one of the study's three sites had additional treatment been required. Also, they note that while the evaluation " shows that [misoprostol] has been very well accepted by both providers and clients, " the study's findings indicate that the drug " did not work…in almost 75% of cases in which gestational age exceeded 12 weeks. " The use of misoprostol for incomplete abortion should be limited to pregnancies of up to 12 weeks, even if a relatively high dose is used, according to a study conducted in Be-nin. 1 Over a five-year period, the percentage of incomplete abortion cases that were successfully treated with 800 mcg of misoprostol (i.e., they did not require manual vacuum aspiration to complete uterine evacuation) was 99% among women with pregnancies of 12 or fewer weeks, compared with 26% among …