Misoprostol is a more satisfactory lower cost-benefit-efficiency outpatient treatment than curettage in first trimester abortion

P Moreno2, E Blanco1, M Blasco3, MV Bellido3, E Marquez1, I Bellido1. 1University of Malaga, Pharmacology and Clinical Therapeutic, Spain, 2Costa del Sol Hospital, Obstetrics and Gynecology Services, Spain, 3Carlos Haya University Hospital, Obstetrics and Gynecology Services, Spain, 4Carlos Haya University Hospital, Surgery Service, Spain

Background: Abortion is the first reason for emergency gynecology consultation. Surgical abortion by curettage is the classic therapeutic choice for first trimester abortion. Medical abortion with the PGE1 prostaglandin analog misoprostol is an alternative less-used method of first trimester pregnancy termination safe, effective and probably most cost-effective option than curettage (1).

Aims: To quantify the efficacy, safety, satisfaction of patients and health-costs of misoprostol vs. curettage in the treatment of first trimester pregnancy abortion.

Methods: After obtaining approval by Malaga University Ethics Review Board and informed consent prior to the study, a prospective, randomized and controlled study in women (18-40 years old) in the first trimester of the pregnancy with deferred abortion, anembryonic gestation, incomplete abortion and inevitable abortion scheduled for therapeutic abortion was done. Women with severe anaemia, thrombopenia, with anticoagulants treatment, with coagulation disorder, allergy to prostaglandins or NSAIDs, hemodynamic instability, fever, endometritis suspicion, abortion led to, abortion in course incomplete or bleeding very heavy and molar gestation suspected were discarded. Patients were randomized to misoprostol (i) 1st day: diagnostic and 1st misoprostol dose at patient home, 800 µg vaginally self-medication + ibuprofen 600 mg/8-12 h; ii) at 8th day: 2nd misoprostol dose at emergency gynecology clinic if necessary after clinical and echographic assessment of not fully expulsion or bag/placenta/rest retained; iii) exceptionally in case of treatment failure at 15th day at emergency gynecology clinic and after clinical and echographic assessment the patient was subjected to curettage. Clinical parameters, main diagnosis, current clinical assessment, gestational age, pregnancy (single/twin), echographic data (embryo’s crown-heel length, gestational sac dimensions, endometrial line, presence of remains before and after the treatment), pain and bleeding before and after the treatment, evolution, complications, hospital stay, re-entry, opinion of the patients (the picker patient experience questionnaire-15), mortality and cost-benefit-efficiency were recorded. Results were analyzed by Student t test, ANOVA test followed by Bonferroni post-test, and Chi-square test.

Results: 102 women (aged 34.4 ± 4.7 years old, 9.7 ± 0.6 gestation weeks) with emergency by current abortion (49.5%), not evolutionary gestation (49.5%) and incomplete abortion (31.8%) were treated with misoprostol (n=50) and curettage (n=52). Misoprostol (M) was significantly more effective than curettage (C) in (M/C): women’s degree of satisfaction with the treatment (6.3±1.4 /8.9±0.9), preventing oxytocin use (37%/62%), hospital stay (28.4±12 h/6.1±1.4 h), and lower cost (2330 €/3020 €) (P<0.05). No significant differences were found for both groups in the post-abortion complications (pain, bleeding, re-entry). A 14% of women of misoprostol group needed curettage.

Conclusion: Misoprostol was an effective and safe outpatient treatment, and more satisfactory for the patient, and lower cost-benefit-efficiency than curettage in first trimester abortion.

Reference: (1) Kulier R et al (2004). Cochrane Database Syst Rev (2): CD002855.