Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries

Shochet, Tara; Diop, Ayisha; Gaye, Alioune; Nayama, M.; Sall, Aissata Bal; Fawole, Bukola; Thiéba, Blandine; Abiola, Okunlola Michael; Dao, Blami; Olayinka, Ogunbode; Winikoff, Beverly

doi:10.1186/1471-2393-12-127

Cited by 39 publications

(55 citation statements)

References 12 publications

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“…These results confirm that 400 mcg sublingual misoprostol effectively evacuates the uterus for most women experiencing incomplete abortion [7]. The high level of satisfaction and overall tolerability of the side effects also attests to the ease of use of this method.…”

Section: Discussionsupporting

confidence: 67%

Results from a study using misoprostol for management of incomplete abortion in Vietnamese hospitals: implications for task shifting

Ngoc¹,

Shochet

Blum

et al. 2013

BMC Pregnancy Childbirth

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BackgroundComplications following spontaneous or induced abortion are a major cause of maternal morbidity. To manage these complications, post-abortion care (PAC) services should be readily available and easy to access. Standard PAC treatment includes surgical interventions that are highly effective but require surgical providers and medical centers that have the necessary space and equipment. Misoprostol has been shown to be an effective alternative to surgical evacuation and can be offered by lower level clinicians. This study sought to assess whether 400 mcg sublingual misoprostol could effectively evacuate the uterus after incomplete abortion and to confirm its applicability for use at lower level settings.MethodsAll women presenting with incomplete abortion at one of three hospitals in Vietnam were enrolled. Providers were not asked to record if the abortion was spontaneous or induced. It is likely that all were spontaneous given the legal status and easy access to abortion services in Vietnam. Participants were given 400 mcg sublingual misoprostol and instructed to hold the pills under their tongue for 30 minutes and then swallow any remaining fragments. They were then asked to return one week later to confirm their clinical status. Study clinicians were instructed to confirm a complete expulsion clinically. All women were asked to complete a questionnaire regarding satisfaction with the treatment.ResultsThree hundred and two women were enrolled between September 2009 and May 2010. Almost all participants (96.3%) had successful completions using a single dose of 400 mcg misoprostol. The majority of women (87.2%) found the side effects to be tolerable or easily tolerable. Most women (84.3%) were satisfied or very satisfied with the treatment they received; only one was dissatisfied (0.3%). Nine out of ten women would select this method again and recommend it to a friend (91.0% and 90.0%, respectively).ConclusionsThis study confirms that 400 mcg sublingual misoprostol effectively evacuates the uterus for most women experiencing incomplete abortion. The high levels of satisfaction and side effect tolerability also attest to the ease of use of this method. From these data and given the international consensus around the effectiveness of misoprostol for incomplete abortion care, it seems timely that use of the drug for this indication be widely expanded both throughout Vietnam and wherever access to abortion care is limited.Trial registrationClinicalTrials.gov, NCT00670761

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Section: Discussionsupporting

confidence: 67%

Results from a study using misoprostol for management of incomplete abortion in Vietnamese hospitals: implications for task shifting

Ngoc¹,

Shochet

Blum

et al. 2013

BMC Pregnancy Childbirth

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“…A recent study utilizing misoprostol for PAC in Senegal showed high efficacy and acceptability [2]. Numerous other studies have produced similar results [3–9].…”

Section: Introductionmentioning

confidence: 83%

Decentralizing postabortion care in Senegal with misoprostol for incomplete abortion

Gaye¹,

Diop²,

Shochet³

et al. 2014

Intl J Gynecology & Obste

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“…Some of these conditions, particularly induced abortion, can be managed by medical therapy as an alternative to surgery. However, evidence shows superior outcomes from surgery, including studies from LMICs . Surgical backup is crucial in case the treatment is unsuccessful.…”

Section: Methodsmentioning

confidence: 99%

Surgically avertable burden of obstetric conditions in low‐ and middle‐income regions: a modelled analysis

Higashi

Barendregt

Kassebaum

et al. 2014

BJOG

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Objective To quantify the burden of maternal and neonatal conditions in low-and middle-income countries (LMICs) that could be averted by full access to quality first-level obstetric surgical procedures.Design Burden of disease and epidemiological modelling.Setting LMICs from all global regions.Population The entire population in 2010.Methods We included five conditions in our analysis: maternal haemorrhage; obstructed labour; obstetric fistula; abortion 1 ; and neonatal encephalopathy. Demographic and epidemiological data were obtained from the Global Burden of Disease 2010 study. We split the disability-adjusted life years (DALYs) of these conditions into surgically 'avertable' and 'non-avertable' burdens. We applied the lowest age-specific fatality rates from all global regions to each LMIC region to estimate the avertable deaths, assuming that the differences of death rates between each region and the lowest rates reflect the gap in surgical care. Main outcome measures Deaths and DALYs avertable.Results Of the estimated 56.6 million DALYs (i.e. 56.6 million years of healthy life lost) of the selected five conditions, 21.1 million DALYs (37%) are avertable by full coverage of quality obstetric surgery in LMICs. The avertable burden in absolute term is substantial given the size of burden of these conditions in LMICs. Neonatal encephalopathy constitutes the largest portion of avertable burden (16.2 million DALYs) among the five conditions, followed by abortion (2.1 million DALYs).Conclusions Improving access to quality surgical care at first-level hospitals could reduce a tremendous burden of maternal and neonatal conditions in LMICs.

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Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries

Cited by 39 publications

References 12 publications

Results from a study using misoprostol for management of incomplete abortion in Vietnamese hospitals: implications for task shifting

Results from a study using misoprostol for management of incomplete abortion in Vietnamese hospitals: implications for task shifting

Decentralizing postabortion care in Senegal with misoprostol for incomplete abortion

Surgically avertable burden of obstetric conditions in low‐ and middle‐income regions: a modelled analysis

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