Giving Misoprostol before Vacuum Aspiration Lowers Risk of Complications

Cervical preparation with misoprostol reduces a woman's risk of complications from a first-trimester vacuum aspiration abortion, according to a multicountry, randomized controlled trial. (1) Although women receiving misoprostol reported more abdominal pain, vaginal bleeding, nausea and other side effects before the abortion than those who received a placebo, they were less likely to report any complications after the procedure (relative risk, 0.7), notably incomplete abortion and incomplete abortion requiring uterine reevacuation. Overall, 2% of misoprostol recipients had a serious complication, compared with 3% of placebo recipients. The researchers sought to assess whether cervical preparation with misoprostol for first-trimester abortion is associated with greater cervical dilation and reduced rates of complications. The trial was conducted from October 2002 to September 2005 at 14 hospitals in Armenia, China, Cuba, Hungary, India, Mongolia, Romania, Slovenia and Vietnam. Women requesting first-trimester pregnancy termination were eligible if they were in the first 84 days of pregnancy and were willing to return for follow-up; they were excluded if they had a known allergy to misoprostol, low hemoglobin levels, or a medical disorder that precluded routine vacuum aspiration or use of misoprostol or similar drugs. Clinic staff recorded women's demographic information and medical histories, and also measured hemoglobin concentrations. Length of pregnancy was determined by ultrasound. Three hours before their abortion, participants received either two 200-mg misoprostol tablets or two placebo tablets, administered vaginally; shortly before the procedure, the women were asked whether they had experienced any side effects from the drug. Study sites varied in the type of surgical equipment used (manual vs. electric aspiration pump; soft vs. metal tubes) and analgesic provided (paracervical block, general anesthesia, none). Women returned for follow-up visits 7-14 days after the abortion. The primary outcome of interest was any immediate or delayed complication following the procedure, including cervical tear, uterine perforation, incomplete abortion, incomplete abortion with uterine reevacuation, or pelvic inflammatory disease. P values were calculated for binary outcomes, and relative risks for continuous measures. Logistic regression and general linear models were used to test interactions. A total of 4,972 women were randomized to either the misoprostol or the placebo group. Participants' mean age was 27 years. Most women were married or cohabiting (70-71%), and 44% in each group had never given birth. The mean length of gestation was 7.9 weeks. For both groups, the average time between misoprostol administration and the abortion was 3.3 hours. During this time, higher proportions of women in the misoprostol group than in the placebo group reported abdominal pain (55% vs. 22%), vaginal bleeding (37% vs. 7%), nausea (7% vs. 4%), diarrhea (2% vs. 0%) and chills (3% vs. 1%); rates of vomiting, fever, dizziness, headache and rash were similar in the two groups (0-4%). Cervical dilation before surgery was significandy greater in the misoprostol group than in the placebo group-7. …