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Abstract

A randomized trial of misoprostol compared with manual vacuum aspiration for incomplete abortion 
Weeks,Andrew; Alia,Godfrey; Blum,Jennifer; Winikoff,Beverly; Ekwaru,Paul; Durocher,Jill M.; Mirembe,Florence
Obstetrics and Gynecology 106(3): 540-547
Publication date: 2005


Objective
To compare the safety, efficacy, and acceptabilityof misoprostol and manual vacuum aspiration for the treatmentof incomplete abortion in a hospital setting in Kampala, Uganda.

Methods
Three hundred seventeen women with clinically diagnosedincomplete first-trimester abortions were randomized to treatmentwith either manual vacuum aspiration or 600 µg misoprostolorally to complete their abortions. All women received antibioticsposttreatment and were followed up 1-2 weeks later.

Results
Regardless of treatment allocation, nearly all womenin this study successfully completed their abortions with eitheroral misoprostol or manual vacuum aspiration (96.3% versus 91.5%,relative risk 1.05, 95% confidence interval 0.98-1.14).Complications were less frequent in those receiving misoprostolthan those having manual vacuum aspiration (0.9% versus 9.8%,relative risk 0.1, 95% confidence interval 0.01-0.78).In the 6 hours after treatment, women using misoprostol reportedheavier bleeding but lower levels of pain than those treatedwith manual vacuum aspiration. Rates of acceptability were similarlyhigh among women in the 2 treatment groups, with 94.2% and 94.7%of women reporting that their treatment was satisfactory orvery satisfactory in the misoprostol and manual vacuum aspirationgroups, respectively.

Conclusion
For treatment of first-trimester uncomplicatedincomplete abortion, both manual vacuum aspiration and 600 µgoral misoprostol are safe, effective, and acceptable treatments.Based on availability of each method and the wishes of individualwomen, either option may be presented to women for the treatmentof incomplete abortion.

Level of Evidence:
I