title: Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  This study has been registered at clinicaltrials.gov as NCT00466999 and NCT01539408.
authors.affiliation: Gynuity Health Projects, 15 E, 26th St, Suite 801, New York, NY 10010, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Shochet
authors.forename: Ayisha
authors.initials: A
authors.lastname: Diop
authors.forename: Alioune
authors.initials: A
authors.lastname: Gaye
authors.forename: Madi
authors.initials: M
authors.lastname: Nayama
authors.forename: Aissata Bal
authors.initials: AB
authors.lastname: Sall
authors.forename: Fawole
authors.initials: F
authors.lastname: Bukola
authors.forename: Thieba
authors.initials: T
authors.lastname: Blandine
authors.forename: Okunlola Michael
authors.initials: OM
authors.lastname: Abiola
authors.forename: Blami
authors.initials: B
authors.lastname: Dao
authors.forename: Ogunbode
authors.initials: O
authors.lastname: Olayinka
authors.forename: Beverly
authors.initials: B
authors.lastname: Winikoff
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal; D000027:Abortion, Incomplete / Q000188:drug therapy* / Q000601:surgery; D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D002050:Burkina Faso; D004107:Dilatation and Curettage; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008435:Mauritania; D008875:Middle Aged; D016595:Misoprostol; D009548:Niger; D009549:Nigeria; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012675:Senegal; D016896:Treatment Outcome; D014619:Vacuum Curettage; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol