Use of Misoprostol to Treat Incomplete Abortion Should Be Limited to the First 12 Weeks of Pregnancy

By Melhado, L. | International Perspectives on Sexual and Reproductive Health, December 2014 | Go to article overview

Use of Misoprostol to Treat Incomplete Abortion Should Be Limited to the First 12 Weeks of Pregnancy


Melhado, L., International Perspectives on Sexual and Reproductive Health


The use of misoprostol for incomplete abortion should be limited to pregnancies of up to 12 weeks, even if a relatively high dose is used, according to a study conducted in Benin. (1) Over a five-year period, the percentage of incomplete abortion cases that were successfully treated with 800 mcg of misoprostol (i.e., they did not require manual vacuum aspiration to complete uterine evacuation) was 99% among women with pregnancies of 12 or fewer weeks, compared with 26% among women with pregnancies of 13-14 weeks and 28% among women with pregnancies of 1518 weeks. In addition, the risk of adverse effects from misoprostol was significantly lower during the first 12 weeks of pregnancy than later in pregnancy.

In 2006, in an effort to reduce the country's high maternal mortality ratio, the government of Benin implemented a policy to improve postabortion care for women who had had spontaneous or induced abortions. Sharp curettage was replaced by manual vacuum aspiration, and in 2008, the use of misoprostol was adopted. Although a substantial body of literature has documented the effectiveness of misoprostol to treat early incomplete abortion, no studies have examined misoprostol's success rate at higher doses to treat incomplete abortions after 12 weeks' gestation. To fill this gap, and to provide a picture of misoprostol use in a low-resource environment with a high demand for postabortion care, researchers conducted a descriptive, prospective study between 2008 and 2012 at three maternity hospitals in Cotonou.

Women were eligible for the study if they were admitted to one of the hospitals with a diagnosis of incomplete abortion (determined by ultrasonography and clinical examination), did not have severe complications requiring immediate treatment and had an estimated gestational age of up to 18 weeks. Those who had stable blood circulation and uterine contents of less than 20 mm were given the option of medical treatment, manual vacuum aspiration, sharp curettage or no treatment, and were counseled about possible adverse effects and the importance of follow-up visits. Women choosing medical treatment were given 800 mcg misoprostol sublingually; follow-up visits were scheduled for three days later (to assess progress) and 15 days later (to perform ultrasound). At the latter visit, the treatment was considered successful if the uterus was empty or if the uterine contents were minimal and the woman was asymptomatic. The treatment was considered a failure if the woman was still bleeding or cramping and the uterus was not empty; at this time, manual vacuum aspiration was performed unless the woman was stable and opted for a second 800 mcg dose of misoprostol. If she opted for misoprostol, the woman was examined again 10-15 days later; if the uterus was still not empty, manual vacuum aspiration was performed. Data were collected on choice of treatment, gestational age at abortion, adverse effects, ultrasound results and need for vacuum aspiration after misoprostol. Chi-square testing was used to assess the differences in success rate and in incidence of adverse effects by gestational age.

In all, 3,139 women were admitted for incomplete abortion during the study period; 630 required no further treatment. Of the remaining 2,509 women, 21% chose treatment with misoprostol. At all three sites, the proportion of women who chose misoprostol rose between 2008 and 2011 (from 8-12% to 25-28%) but declined in 2012 (to 21-27%). …

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Use of Misoprostol to Treat Incomplete Abortion Should Be Limited to the First 12 Weeks of Pregnancy
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