A Randomized Trial of Hospital Vs Home Self Administration of Vaginal Misoprostol for Medical Abortion

Abstract

BackgroundA combination of mifepristone followed after 24 hrs by misoprostol has proved a safe and effective abortifacient for termination of early pregnancy. Home use of misoprostol for medical abortion is still controversial in many countries including ours where women's literacy rate is low. Particularly in developing countries, this method markedly decreased the hospital visit which would be beneficial to patients and hospital staff. ObjectiveTo see whether the home self administration of vaginal misoprostol was equally effective as administered by trained staff in terms of successful termination of early pregnancy. Secondary outcomes were bleeding and pain duration during medical abortion, side effects, reason for termination of pregnancy and women's acceptability of the procedure. MethodOne hundred and eighty eight women requesting medical abortion with pregnancy less than 63 days gestation were randomized into two groups either self administration of vaginal misoprostol (800 mcg) at home or hospital administration 24 hours after oral 200 mg mifepristone. Ultrasound was performed after 14 days to confirm complete abortion. ResultThe overall success rate was similar in two groups: 89.13% on home group Vs 86.9% in hospital group. Eleven out of 18 women (61.1%) having incomplete abortion had successful termination after 2 nd dose misoprostol( 400 mcg). None of the women had continued pregnancy. Multigravida had slightly higher risk of failure (R.R: 1.04). ConclusionHome self administration of vaginal misoprostol was safe and effective for early termination of medical abortion and was acceptable. Use of extra dose of misoprostol has advantage of higher completion rate of abortion.

Early medical abortion with self‐administered low‐dose mifepristone in combination with misoprostol

“…29 In a prospective, comparative, non-randomized, open-label study in Nepal, Conkling et al found that self-administration of vaginal misoprostol was safe and effective for termination within 63-day LMP. 30,31 In this study, we found that home administration of low-dose misoprostol was highly acceptable. Although the satisfaction rates for the H-Mis and S-Mis groups were both high, participants indicated that they preferred self-administration owing to convenience and privacy protection.…”

“…In a prospective, comparative, non‐randomized, open‐label study in Nepal, Conkling et al . found that self‐administration of vaginal misoprostol was safe and effective for termination within 63‐day LMP …”

Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19

“…Three studies were RCTs, and included data from 1452 women. [21][22][23] Sixteen studies were NRSs and included data from 10 124 women. 16 17 24-36 Sixteen studies were conducted in lowto-middle resource settings (Bangladesh, 25 26 India, 28 30 34 Nepal, 22 31 China, 21 23 Vietnam, 32 33 35 Tunisia, 29 35 Nigeria, 36 Albania 27 and Turkey 24 ).…”

“…35 Participants' maximum gestational age was under 9 weeks for 14 studies, 16 17 21 23 24 27- 29 31-35 and up to and including 9 weeks for the other five studies. 22 25 26 30 36 Statistically significant differences between participants in the homebased and clinic-based groups were reported on variables including primigravida, parity, age and gestational age in six studies. 16 17 28-30 32 All studies used a combination regimen that involved the administration of mifepristone and misoprostol.…”

Safety, Efficacy and Acceptability of Early First Trimester Abortion using Oral Mifepristone and Sublingual Misoprostol

“…5 Several studies have studied the vaginal use of misoprostol. 1,5,8 Our study evaluated the efficacy, side effects and acceptability of its sublingual use.…”