Sublingual Misoprostol Versus Manual Vacuum Aspiration for Treatment of Incomplete Abortion in Nigeria: A Randomized Control Study

Abstract

Objectives: To compare the effectiveness of single-dose sublingual misoprostol to manual vacuum aspiration in the treatment of incomplete spontaneous abortion in Enugu, Nigeria.Design: Multi-centre randomized controlled trialSetting: A teaching hospital, the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu and a private specialist hospital, Julius Memorial Specialist Hospital Enugu, Nigeria were used for the studyParticipants: In all, 212 consecutive consenting women with sonologically confirmed, first-trimester incomplete spontaneous abortion at the gynaecological emergency departments of the study centers were recruited but, 203 women completed the study and their results analysed.Intervention: Single-dose of sublingual misoprostol 400mcg with the participant followed-up at the gynecology clinic one week after with an ultrasound scan for the completeness of the uterine evacuation. Main outcomes measures: The primary outcome measure was the incidence of complete uterine evacuation (complete abortion) after one week of treatment while the secondary outcome measures included incidence, types, and tolerability of treatment side effects as well as participants’ satisfaction with the treatment receivedResults: Two hundred and three eligible women were randomised into the intervention group (n = 102) that received single-dose sublingual misoprostol 400mcg and the control group (n = 101) that received manual vacuum aspiration. Incidence of complete abortion was 86.3% for the misoprostol group and 100.0% for the control group, RR = 0.86, (CI 95%: 0.80 - 0.93), p <0.001. The most common side effect was abdominal pain with an incidence of 27.5% versus 48.55 for the misoprostol and control groups respectively (p = 0.002). Most participants in each group (81.1% versus 77.6% for the misoprostol and control groups respectively) considered the side effects as tolerable. The mean visual analogue scale score for maternal satisfaction was higher in the misoprostol group (86.7 ± 14.11) than the control group (81.36 ± 11.10), p < 0.001. Conclusions: The treatment of incomplete spontaneous abortion with single-dose sublingual misoprostol 400mcg produced a high rate of complete abortion among women in Enugu, Nigeria. Despite having a lower complete abortion rate, maternal satisfaction was higher when compared with women that had manual vacuum aspiration of the uterus. Trial registration: Trial registration number - PACTR202009857889210, date of registration - 23 September 2020. Retrospectively registered

Comparison of misoprostol and manual vacuum aspiration in treating first-trimester incomplete miscarriage: a systematic review and meta-analysis of randomized controlled trials

“…Misoprostol is a promising medical treatment option as an alternative of MVA for its satisfactory rate of complete uterine evacuation, and tolerable adverse events. So far, several studies have been launched to appraise the feasibility of misoprostol as an alternative of MVA in conditions where medical equipment like ultrasonography or well-trained surgeons were not available, but the results of these studies varied from one another [13][14][15][16][17][18][19] . Consequently, we carried out this systematic review and meta-analysis to evaluate the relative e cacy, safety concerns and patients' subjective evaluation of misoprostol and MVA.…”

“…With a purpose to guide the choice between MVA and misoprostol in rst trimester incomplete abortion, several high-quality prospective randomized controlled trials have been carried out to weigh their e ciency for complete uterine evacuation as well as safety concerns, while inconsistency came up among studies [13][14][15][16][17][18][19] . Particularly, the prevalence of adverse events following MVA or misoprostol use in rst trimester incomplete abortion have varied greatly among different studies.…”

Interpregnancy interval after a miscarriage and obstetric outcomes in the subsequent pregnancy in a low-income setting, Nigeria: A cohort study

“…The convenience of medical method, reduction of occurrence of uterine syne chiae, absence of use of anaesthesia and the resultant compa rable outcomes with surgical methods made it an easier and convenient method of uterine evacuation recently. 36,37 The use of medical management also reduces drastically the need for specialized surgical skills and therefore encourages task shifting and task sharing, making it easy to use even in secondary 34 and primary health care facilities. 38 Overall, there were no significant differences in adverse obstetric and perinatal risk to the mother and baby, between the two groups studied.…”

Manual Vacuum Aspiration During Early Pregnancy Failure: A Comparison of Sublingual and Vaginal Misoprostol for Pain Management

“…One research on women undergoing a voluntary termination of pregnancy reported that discomfort with misoprostol by sublingual route was 58+2.2 and vaginal route was 46.6+2.8 intraoperatively, which is comparable to our findings. 17 In a recent study 18 it was revealed that 203 patients were enrolled meeting the requirements for enrollment and ready to properly follow the protocol explained. Analysis of the data showed that percentage of the patients with complete abortions on misoprostol was 86% versus 100% in control group (p <0.01).…”