Is Misoprostol a Suitable Alternative to the Surgical Evacuation of Incomplete Abortion in Rural South-eastern Nigeria?

BACKGROUND Research has demonstrated the effectiveness of misoprostol for treatment of incomplete abortion. However, few studies have focused on the feasibility of treating incomplete abortion with misoprostol at the rural clinic level in sub-Saharan Africa. OBJECTIVE To determine the effectiveness, safety and acceptability of misoprostol as an alternative to the surgical treatment of incomplete abortion at a rural clinic. DESIGN Open-label randomised controlled trial. SETTING A private clinic in Ekeakpara community, Osisioma Ngwa Local Government Area, Abia State, Nigeria. SUBJECTS Women of reproductive age presenting with incomplete abortion. RESULTS Regardless of treatment allocation, nearly all women had a complete uterine evacuation with either oral misoprostol or manual vacuum aspiration (misoprostol: 98.8%, MVA: 100%, P = 0.99). Misoprostol users were more likely to report that they were'very satisfied'with the method (75.6% versus 45%, P<0.001). In the 72 hours after treatment, women using misoprostol reported heavier bleeding but lower levels of pain than those treated with manual vacuum aspiration. Women in the misoprostol group were more likely to choose that treatment again (96.9 versus 55.6%; P<0.001) and would recommend it to a friend. CONCLUSION For treatment of first-trimester uncomplicated incomplete abortion at a rural facility, both MVA and 600 μg oral misoprostol are safe, effective, and acceptable treatments. Depending on availability of each method and the desires of individual women, either option may be presented to women for the treatment of incomplete abortion.