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Misoprostol for treatment of incomplete abortion at the regional hospital level: results from Tanzania

  1. B Shwekerela1,
  2. R Kalumuna1,
  3. R Kipingili1,
  4. N Mashaka1,
  5. E Westheimer2,
  6. W Clark3,*,
  7. B Winikoff3

Article first published online: 5 SEP 2007

DOI: 10.1111/j.1471-0528.2007.01469.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 114, Issue 11, pages 1363–1367, November 2007

Additional Information

How to Cite

Shwekerela, B., Kalumuna, R., Kipingili, R., Mashaka, N., Westheimer, E., Clark, W. and Winikoff, B. (2007), Misoprostol for treatment of incomplete abortion at the regional hospital level: results from Tanzania. BJOG: An International Journal of Obstetrics & Gynaecology, 114: 1363–1367. doi: 10.1111/j.1471-0528.2007.01469.x

Author Information

  1. 1

    Kagera Regional Hospital, Bukoba, Tanzania

  2. 2

    Mount Sinai School of Medicine, New York, NY, USA

  3. 3

    Gynuity Health Projects, New York, NY, USA

*Dr W Clark, Gynuity Health Projects, 15 East 26th Street, #1617 New York, NY 10010 USA. Email wclark@gynuity.org

Publication History

  1. Issue published online: 5 SEP 2007
  2. Article first published online: 5 SEP 2007
  3. Accepted 10 January 2007. Published OnlineEarly 5 September 2007.

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Keywords:

  • Incomplete abortion;
  • miscarriage;
  • misoprostol;
  • rural health;
  • Tanzania

Objective  To investigate the safety, efficacy, and acceptability of misoprostol versus manual vacuum aspiration (MVA) for treatment of incomplete abortion.

Design  A prospective open-label randomised trial.

Setting  Kagera Regional Hospital, Bukoba, Tanzania.

Sample  Three hundred women with a clinical diagnosis of incomplete abortion and a uterine size <12 weeks.

Methods  A total of 150 women were randomised to either a single dose of 600 micrograms of oral misoprostol or MVA. If abortion was clinically complete at 7-day follow up, the woman was released from the study. If it was still incomplete, the woman was offered the choice of an additional 1-week follow up or immediate MVA. Cases still incomplete after a further week were offered MVA.

Main outcome measures  Incidence of successful abortion (success defined as no secondary surgical intervention provided), incidence of adverse effects, patient satisfaction.

Results  Success was very high in both arms (misoprostol: 99%; MVA: 100%; difference not significant). Most adverse effects were higher in the misoprostol arm, although the mean pain score was higher in the MVA arm (3.0 versus 3.5; P < 0.001). More women were very satisfied with misoprostol (75%) than with MVA (55%, P= 0.001), and a higher proportion of women in the misoprostol arm said that they would recommend the treatment to a friend (95% versus 75%, P < 0.001).

Conclusion  Misoprostol is as effective as MVA at treating incomplete abortion at uterine size of <12 weeks. The acceptability of misoprostol appears higher. Given the many practical advantages of misoprostol over MVA in low-resource settings, misoprostol should be more widely available for treatment of incomplete abortion in the developing world.

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