Misoprostol substantially reduces serious complications in early termination of pregnancy

Misoprostol is commonly used for cervical preparation prior to surgical abortion (vacuum aspiration) because it is effective, widely available, easy to use, and cheap. But until now, no studies have been large enough to assess whether misoprostol affects the occurrence of immediate or delayed (a few weeks after) serious complications from surgical abortion.

In this study, Eduardo Bergel from WHO, Geneva, Switzerland and colleagues compared rates of complications (cervical tear, uterine perforation, incomplete abortion, pelvic inflammatory disease, or any other serious event) of vacuum aspirations. 4972 women requesting a termination of early pregnancy (before 12 weeks gestation) from 14 centres in nine countries were randomly assigned to vaginal misoprostol (2485 women) or placebo (2487 women) 3 hours before aspiration.

Women given misoprostol were nearly a third less likely to experience one complication or more compared to those receiving placebo. Additionally, the risk of incomplete abortion was almost three times higher in the placebo group than in the misoprostol group. Minor cervical tears and uterine perforations were also less common in the misoprostol group.

Abdominal pain, vaginal bleeding, and nausea were more frequent after treatment with misoprostol during the 3 hours prior to surgery. But no differences in the incidences of pelvic inflammatory disease or other serious adverse events were noted between the groups.

The authors conclude: "Misoprostol reduced the overall incidence of complications, particularly incomplete abortions and unscheduled clinic visits and hospital admissions after abortion…Providers should be aware of the side-effects of the drug and inform women about these effects."

In an accompanying Comment, Allan Templeton from the University of Aberdeen in Scotland says: "The important issue…is the balance between effectiveness of the procedure and the side-effects of misoprostol, which will include abdominal cramps and vaginal bleeding in most women, although not to the extent of needing medical intervention before surgery."

In light of these new findings he adds: "Surely routine pharmaceutical dilation of the cervix should be recommended as an integral part of surgical abortion in all women."

Provided by Lancet