The use of misoprostol for treatment of incomplete abortion: a feasibility study in Nepal
ESC Congress Library. Edelman A. 05/28/14; 50436; A-018 Disclosure(s): The research was support by Ipas; the authors are either employees or consultants of Ipas. Dr. Edelman otherwise has no disclosures specific to this research but is a consultant to the U.S. CDC, WHO, and FDA; receives grant funding from USAID, Gates Foundation, and the NIH; receives royalties as an author for UpToDate; and is a trainer for Merck (Nexplanon).
Assoc. Prof. Alison Edelman
Assoc. Prof. Alison Edelman
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Abstract
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Objectives: Since legalization of abortion in 2002, the Nepal Ministry of Health and Population has increased access to safe, abortion services through facility improvements, provider training, and community education. At the primary level, auxiliary nurse midwives (ANMs) with skilled birth attendant (SBA) certification receive training in manual vacuum aspiration (MVA) to manage post abortion complications. However, limited clinical practice during training and infrequent presentation of women for this service leads to lack of confidence and clinical competence and few ANMs actually provide post abortion care (PAC). Medical management of abortion complications including incomplete and missed abortion treated with misoprostol is an effective alternative to surgical intervention.  The purpose of this study was to determine the feasibility of misoprostol for PAC in Nepal. 


Methods: A cross-sectional descriptive study of women presenting for PAC at 3 health facilities over a 4 month time period (April to June, 2013).  Women were eligible for the study and underwent informed consent if they presented with vaginal bleeding or a history of vaginal bleeding during the current pregnancy with a uterine size of 12 weeks or less, had an open cervical os, stable vital signs and choose medical management (400mcg misoprostol sublingual). History and physical exam were performed and demographics obtained. Women were contacted by providers via telephone within 24-48 hours to determine well-being and an in-person visit scheduled at 6-10 days to confirm abortion completion.


Results: A total of 210 women presented for PAC during the study period; 62 women desired medical management with misoprostol and 100% were enrolled in the study. Women were young [25.6 years (SD=25)], 50% were nulliparous and most reported not using contraception over the previous 6 months (79%).  Providers were able to make contact by phone with 61 women (98%) within 24-48 hours of their treatment. Only 4 women reported any concerning issues (vomiting, bleeding, persistent pain, and no bleeding) and were recommended to seek care.  Fifty-five women presented for their follow up visit; 52 [OU1] had completed their abortion and the 3 remaining underwent an uncomplicated MVA, 22 reported taking the pain management provided, and 20 accepted a contraceptive method.  Over 90% reported that they would recommend this treatment to a friend or family member.


Conclusions:  This study provides evidence that misoprostol for PAC appears safe in women with stable vital signs and may be a useful option in remote, low resource settings.


 

Objectives: Since legalization of abortion in 2002, the Nepal Ministry of Health and Population has increased access to safe, abortion services through facility improvements, provider training, and community education. At the primary level, auxiliary nurse midwives (ANMs) with skilled birth attendant (SBA) certification receive training in manual vacuum aspiration (MVA) to manage post abortion complications. However, limited clinical practice during training and infrequent presentation of women for this service leads to lack of confidence and clinical competence and few ANMs actually provide post abortion care (PAC). Medical management of abortion complications including incomplete and missed abortion treated with misoprostol is an effective alternative to surgical intervention.  The purpose of this study was to determine the feasibility of misoprostol for PAC in Nepal. 


Methods: A cross-sectional descriptive study of women presenting for PAC at 3 health facilities over a 4 month time period (April to June, 2013).  Women were eligible for the study and underwent informed consent if they presented with vaginal bleeding or a history of vaginal bleeding during the current pregnancy with a uterine size of 12 weeks or less, had an open cervical os, stable vital signs and choose medical management (400mcg misoprostol sublingual). History and physical exam were performed and demographics obtained. Women were contacted by providers via telephone within 24-48 hours to determine well-being and an in-person visit scheduled at 6-10 days to confirm abortion completion.


Results: A total of 210 women presented for PAC during the study period; 62 women desired medical management with misoprostol and 100% were enrolled in the study. Women were young [25.6 years (SD=25)], 50% were nulliparous and most reported not using contraception over the previous 6 months (79%).  Providers were able to make contact by phone with 61 women (98%) within 24-48 hours of their treatment. Only 4 women reported any concerning issues (vomiting, bleeding, persistent pain, and no bleeding) and were recommended to seek care.  Fifty-five women presented for their follow up visit; 52 [OU1] had completed their abortion and the 3 remaining underwent an uncomplicated MVA, 22 reported taking the pain management provided, and 20 accepted a contraceptive method.  Over 90% reported that they would recommend this treatment to a friend or family member.


Conclusions:  This study provides evidence that misoprostol for PAC appears safe in women with stable vital signs and may be a useful option in remote, low resource settings.


 

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