COMPARATIVE TRIAL OF MISOPROSTOL VERSUS MVA IN THE MANAGEMENT OF FIRST TRIMESTER SPONTANUEOUS MISCARRIAGE

Abstract

Abortion is an important public health problem and an important cause of maternal mortality. Surgical evacuation or MVA is the standard treatment; however, access to this procedure is often hampered by lack of skilled personnel and facilities. In these settings, misoprostol could save many lives by providing treatment that can be administered even at the most basic rural health center. The study was designed to fill a gap in literature by testing the administration of misoprostol (medical treatment) in first trimester spontaneous incomplete and missed miscarriage in a hospital setting, in low income country with restrictive abortion law. The aim of the study was to compare misoprostol with MVA in evacuating the uterus in first trimester spontaneous miscarriage. This was a randomized control trial involving 120 consenting women (60 women to each group) with first trimester incomplete and missed miscarriage. The method allocation was blinded to the patients and the attending doctor using computer generated random numbers in a sealed opaque envelope. Pre treatment packed cell volume; blood group, bedside clotting time and trans abdominal ultrasound were done for both groups. Those in the misoprostol group received 600µg misoprostol orally for incomplete abortion and sublingually for missed abortion while manual vacuum aspiration (MVA) was done using a Karman’s syringe under aseptic technique for the MVA group. The patients were followed up weekly for two weeks and had pelvic examination and ultrasound done on each week to confirm complete evacuation. A PCV was done for both groups after the completion of treatment. A data form was filled for the patient’s and those who have incomplete abortion after two weeks in the misoprostol group had it completed with MVA The outcome of the study showed that 600µg of misoprostol was less effective than MVA in complete evacuation of the uterus, 73.3% versus 98.3%, which was statistically significant. There was no statistical significant difference in the blood loss between the two groups and no case of genital sepsis. However patients who had MVA had higher pain scores compared to the misoprostol group, which was statistically significant. Misoprostol was more effective in incomplete abortion compared to missed abortion which was statistically significant; side effects were few of which nausea and shivering were commonest. Misoprostol use was associated with high levels of patient satisfaction.

COMPARATIVE TRIAL OF MISOPROSTOL VERSUS MVA IN THE MANAGEMENT OF FIRST TRIMESTER SPONTANUEOUS MISCARRIAGE