Scientific Paper Abstracts Originally Presented at the National Abortion Federation's Annual Meeting; April 23, 2007; Boston, Massachusetts

In This Article

Misoprostol for Treatment of Incomplete Abortion in Madagascar and Moldova

Ayisha Diop, MPH; Sheila Raghavan, MSc; J.P. Rakotovao, MD, MPH; Rodica Comendant, MD, PhD; Paul Blumenthal, MD, MPH; Beverly Winikoff, MD, MPH

Introduction and Purpose/Objective(s): A 600 mcg oral dose of misoprostol is highly effective for treatment of incomplete abortion. Pharmacokinetic studies show that oral and sublingual routes produce the shortest time to peak serum levels of misoprostol, with sublingual administration resulting in prolonged high serum levels. Because of this, sublingual misoprostol may permit a lower dose for treatment of incomplete abortion.

Data-Collection Methods: 300 women in two countries, Madagascar (N=200) and Moldova (N=100), < 12 weeks' LMP seeking treatment for clinically diagnosed incomplete abortions were randomized at two tertiary-level hospitals to receive either 600 or 400 mcg misoprostol orally or sublingually, respectively. Incomplete abortion was diagnosed through clinical examination based on past or present history of vaginal bleeding during pregnancy and an open cervical os. Parecetemol was provided to women as needed to manage pain. Success was defined as a completed abortion without surgical intervention. Women returned for follow-up and evaluation of abortion status after 7 days. Women with a continued incomplete abortion were offered an extended follow-up visit (up to 15 days) or immediate surgical evacuation. Exit interviews were conducted once the abortion was completed.

Summary of Results: Results show high success rates for both routes: 94.5% for sublingual and 94.6% for oral. 97% of women in both groups reported being either satisfied or very satisfied with the treatment. The majority of women (75%) also reported side effects to be tolerable. Over 82% of women correctly self-assessed their abortion status, compared to clinician assessment. Women reported that the best features of the treatment were that it was quick, easy, convenient, and avoided surgical intervention. Worst features cited included bleeding, nausea, weakness and pain.

Conclusions: Both 400 mcg sublingual misoprostol and the 600 mcg oral dose appear to have comparable safety and efficacy profiles for the treatment of incomplete abortion. This reduced dose may have important implications in terms of cost and availability, and could help expand services for this indication in Madagascar and Moldova as well as other low-resource countries.

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