Is misoprostol a safe, effective and acceptable alternative to manual vacuum aspiration for postabortion care? Results from a randomised trial in Burkina Faso, West Africa.
OBJECTIVE
Previous research has demonstrated the effectiveness of misoprostol for treatment of incomplete abortion; however, few studies have systematically compared misoprostol's effectiveness with that of standard surgical care. This study documents the effectiveness of a single 600 micrograms dose of oral misoprostol versus manual vacuum aspiration (MVA) for treatment of incomplete abortion in a developing country setting.


METHODS
Open-label randomised controlled trial.


METHODS
Two university teaching hospitals in Burkina Faso, West Africa.


METHODS
Women of reproductive age presenting with incomplete abortion.


METHODS
From April 2004 through October 2004, 447 consenting women with incomplete abortion were randomised to either a single dose of 600 micrograms oral misoprostol or MVA for treatment of their condition.


METHODS
Completed abortion following initial treatment.


RESULTS
Regardless of treatment assigned, nearly all participants had a complete uterine evacuation (misoprostol = 94.5%, MVA = 99.1%; relative risk [RR] = 0.95 [95% CI 0.92-0.99]). Acceptability and satisfaction ratings were similar and high for both misoprostol and MVA, with three out of four women indicating that the treatment's adverse effects were tolerable (misoprostol = 72.9%, MVA = 75.8%; RR = 0.96 [95% CI 0.86-1.07]). The majority of women were 'satisfied' or 'very satisfied' with the method they received (misoprostol = 96.8%, MVA = 97.7%; RR = 0.99 [95% CI 0.96-1.02]), expressed a desire to choose that method again (misoprostol = 94.5%, MVA = 86.6%; RR = 1.09 [95% CI 1.03-1.16]) and to recommend it to a friend (misoprostol = 94.5%, MVA = 85.2%; RR = 1.11 [95% CI 1.04-1.18]).


CONCLUSIONS
Six hundred micrograms of oral misoprostol is as safe and acceptable as MVA for the treatment of incomplete abortion. Operations research is needed to ascertain the role of misoprostol within postabortion care programmes worldwide.
Dao
B
B
Centre Hospitalier National Souro Sanou, Bobo Dioulasso, Burkina Faso.
Blum
J
J
Thieba
B
B
Raghavan
S
S
Ouedraego
M
M
Lankoande
J
J
Winikoff
B
B
D000019:Abortifacient Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000027:Abortion, Incomplete / Q000628:therapy*; D000028:Abortion, Induced / Q000379:methods*; D002050:Burkina Faso; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects*; D017060:Patient Satisfaction; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D014619:Vacuum Curettage / Q000379:methods*