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

نویسندگان

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

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.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

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 incompl...

متن کامل

Comparison of vaginal and sublingual misoprostol for second trimester abortion: randomized controlled equivalence trial.

BACKGROUND To identify an effective misoprostol-only regimen for the termination of second trimester pregnancy, we compared sublingual and vaginal administration of multiple doses of misoprostol in a randomized, placebo-controlled equivalence trial. METHODS Six hundred and eighty-one healthy pregnant women requesting medical abortion at 13-20 weeks' gestation were randomly assigned within 11 ...

متن کامل

Results from a study using misoprostol for management of incomplete abortion in Vietnamese hospitals: implications for task shifting

BACKGROUND Complications following spontaneous or induced abortion are a major cause of maternal morbidity. To manage these complications, post-abortion care (PAC) services should be readily available and easy to access. Standard PAC treatment includes surgical interventions that are highly effective but require surgical providers and medical centers that have the necessary space and equipment....

متن کامل

Introducing misoprostol for the treatment of incomplete abortion in Nigeria.

Despite legal restriction, induced abortions and resulting complications are common in Nigeria. Misoprostol administration for incomplete abortion was introduced in 3 Nigerian hospitals. The feasibility of the hospitals, patient and provider acceptability were assessed using questionnaire and interview guides administered to 205 women and 17 providers respectively. Amongst the women, 194 (95%) ...

متن کامل

Comparison of Efficacy and Side Effects of Different Administration Routes of Misoprostol (Oral, Vaginal, and Sublingual) for Second-Trimester Abortion

Background The current study was designed to compare the effectiveness and side effects of oral, vaginal, and sublingual misoprostol in termination of second-trimester pregnancy. Materials and Methods: In this clinical trial (2014 to 2015), 85 pregnant women in the second trimester of pregnancy were included in Imam Reza hospital, Kermanshah, Iran. They were randomly divided into three groups a...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 12  شماره 

صفحات  -

تاریخ انتشار 2012