1. Comparison of Surgical Management with Manual Vacuum Aspiration and Medical Management with Misoprostol for Early Pregnancy Failure in Nnewi, south-east Nigeria
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Authors: 2Nwosu BO, 1Eleje GU, 3Obi-Nwosu A
1 Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State,
Nigeria.
2 Chimex Specialist Hospital, Nnewii, Anambra State, Nigeria.
3 Department of Family Medicine, Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria.
Introduction
Results
Misoprostol is increasingly being used to treat women who have early pregnancy failure. In clinically recognized pregnancies, early pregnancy failure constitute 15% of it. Recently, there are increasing concern on whether immediate
evacuation by surgical intervention is warranted especially in uncomplicated cases of early pregnancy failure. Medical management with misoprostol appears to offer more prompt evacuation of the uterus and has become an increasingly
popular alternative. However, the efficacy and safety of this approach have yet
to be established in Nigeria.
OBJECTIVES
To determine the efficacy and safety of surgical management of early pregnancy failure with manual vacuum aspiration (MVA) versus medical management with misoprostol.
This study was done in Chimex Specialist Hospital, Nnewi, south-east Nigeria. A total of 43 women with a first-trimester pregnancy failure (anembryonic gestation or incomplete or inevitable spontaneous abortion) were randomly assigned to receive 800 μg of misoprostol vaginally or to undergo manual vacuum aspiration (standard of care) in a 5:1 ratio. The misoprostol group received treatment on day 1, a second dose on day 3 if expulsion was incomplete and vacuum aspiration on day 8 if expulsion was still incomplete. Surgical treatment (for the misoprostol group) or repeated aspiration (for the vacuum-aspiration group) within 30 days after the initial treatment constituted treatment failure.
Thirty six and seven women were assigned to receive misoprostol and surgical treatment respectively. Of the 36 women assigned to receive misoprostol, 77.8% (28/36) had complete expulsion after first dose of misoprostol (by day 3) and 2.8% (1/36) after second dose of misoprostol (by day 8). Seven women had MVA after repeat of misoprostol, hence the treatment failed in 19.4% (7/36) of the misoprostol group and none (0/7) in the surgical group (P<0.001). There were no reported adverse effects in any of the groups. None of the women received any contraceptive method prior to conception or supplementary pain management after the pregnancy evacuation.
Conclusions
Treatment of early pregnancy failure with 800 μg of misoprostol vaginally is a safe and effective approach in Nigeria, with a success rate of approximately 80% in comparison to surgical evacuation. Larger studies in Nigeria are needed to compare these findings.
Methods
References
Ayudhaya OP, Herabutya Y, Chanrachakul B, Ayuthaya NI, O-Prasertsawat P. A comparison of the efficacy of sublingual and oral misoprostol 400 microgram in the management of early pregnancy failure: a randomized controlled trial. J Med Assoc Thai Oct;89 Suppl 4:S5-10.
Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM; National Institute of Child Health Human Development (NICHD) Management of Early Pregnancy Failure Trial. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med Aug 25;353(8):761-9.