Comparison of the Efficacy of Misoprostol and Manual Vacuum Aspiration for the Treatment of the First Trimester Termination of the Pregnancy.

Abstract

Objective: Objective of this study was to compare the efficacy of misoprostol and manual vacuum aspiration for the treatment of the first trimester termination of pregnancy. Study Design: Randomized controlled trial Setting: This study was carried out in department of obstetrics and gynaecology of Nishtar Hospital Multan. Duration of Study: This study was conducted from December 2016 to May 2017. Material and methods: A total of 652 women with gestational age ≤ 12 weeks with open cervical os were included in the study. Women with scarred uterus and multiple pregnancies or having asthma, heart disease, jaundice, glaucoma or known sensitivity to prostaglandin were excluded. Total women were divided into two groups. 326 in misoprostol group while 326 in manual vacuum aspiration group. Misoprostol group received misoprostol tablet 400 mcg vaginally every 4 hour for a maximum of three doses, according to cervical softening, dilatation and uterine contractions. Oxytocin infusion was started after 6 hours of first dose administration, at a rate of 2 mIU/min with increments of 1mIU/min after every 30 minutes, to a maximum of 8 mIU/min. Manual vacuum aspiration group had not receive any uterotonics and directly underwent manual vacuum aspiration. Patients were called on 7th day of procedure for follow up. Transvaginal ultrasonograph was performed, to measure the endometrial thickness at the maximum anteroposterior diameter on the long-axis view of the uterus. Efficacy was measured in form of complete abortion. Results: Age range in this study was from 18 to 40 years with mean age of 31.791±4.86 years in misoprostol group while 32.386±4.83 years in manual vacuum aspiration group. Majority of the patients were between 31-35 years in both groups. Mean gestational age was 9.892 ±1.38 weeks in misoprostol group and 9.871±1.22 weeks in manual vacuum aspiration group, while mean doses in misoprostol group was 2.358±0.65. Efficacy was seen in 94.2% patients in misoprostol group as compare to 92% in manual vacuum aspiration group (P=0.148). Conclusion: For the treatment of the first trimester termination, both manual vacuum aspiration and 400 µg intravaginal misoprostol are effective treatments. Based on availability of each method and the wishes of individual women, either option may be presented to women for the treatment of the first trimester termination.

Keywords: Abortion, Misoprostol, Manual vacuum aspiration.