Post-abortion complications much lower after self-induced abortion using misoprostol, 1990s data from Brazil.
(Complications and side effects)
Misoprostol (Complications and side effects)
Misoprostol (Dosage and administration)
|Publication:||Name: Reproductive Health Matters Publisher: Elsevier Science Publishers Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2010 Reproductive Health Matters ISSN: 0968-8080|
|Issue:||Date: Nov, 2010 Source Volume: 18 Source Issue: 36|
|Topic:||Event Code: 310 Science & research|
|Geographic:||Geographic Scope: Brazil Geographic Code: 3BRAZ Brazil|
The high incidence of abortion in Brazil and the increased use of
misoprostol among women having clandestine/unsafe abortions led to an
interest in evaluating the association between the use of misoprostol
and the incidence of septic complications post-abortion. A retrospective
cohort study, published in 1996, included all 1,840 women treated for
complications of abortion at the Instituto Materno-Infantil de
Pernambuco, Recife, between January 1988 and December 1992.
In the univariate analysis, the incidence of infection was significantly lower in women stating they had used misoprostol (4.2%) than in those stating that the abortion was not induced i.e. spontaneous (7.9%, p=0.043) and was 12 times lower than in women stating that they had used other methods for inducing abortion (49.4%, p<0.001). There was no significant difference in incidence of serious infection between the misoprostol group (0.8%) and those claiming the abortion was not induced (0.9%). However, women who reported using other methods for induced abortion had 18 times more serious infections (14.6%) than women using misoprostol (p<0.001). In the multivariate analysis, factors associated with infection were gestational age and woman's age. Induction of abortion with a method other than misoprostol was the only variable associated with serious infection (p<0.001). Misoprostol has an uterotonic effect with softening and dilation of the cervical canal, and therefore the possibility of infection is lower than if the abortion is induced by manipulation of the cervical canal and insertion of an instrument into the uterine cavity, especially when aseptic conditions are not met. These results suggest that misoprostol with an evidence-based dosage and regimen is a safer method for inducing abortion, including in a country like Brazil where abortion is not freely available because it is legally restricted, because it leads to fewer complications and consequently shorter hospital stays for post-abortion care. (1)
Another study had a retrospective and a prospective component. The total sales of misoprostol (Cytotec), the total number of abortion complications admitted to hospital, and the total number of deliveries occurring in the six public hospitals in the city of Goiana, Goias state, Brazil, from 1987 through 1991, were recorded. At the same time, all death certificates and hospital records of women aged 10-49 with abortion-related maternal deaths were investigated and home visits made for further details when deemed necessary. Trends over time in misoprostol sales, abortion and delivery admissions and abortion-related deaths were analysed. The prospective study consisted of daily interviews with all women admitted with abortion complications to the Goiana General Hospital during a 12-month period in 1994. They were asked if they were using a contraceptive method at the time they got pregnant, and if not, why; if they did anything to get their menses back or if they induced an abortion; if they used misoprostol, how many tablets and by which route they had used them. Abortion complications were recorded and their association with the abortion method used was analysed.
The study found that sales of misoprostol increased from 17,000 bottles of 28 tablets of 200 mcg in 1987, to almost 18,000 in 1988, to 50,000 in 1989, and remained at 42,000-52,000 in 1990-91. The numbers of women admitted with abortion complications varied little, remaining at around 1,000 cases per year, while the numbers of deliveries went down from almost 8,400 in 1987 to less than 7,000 in 1991, following the Brazilian trend towards reduced fertility. There were three abortion-related deaths in 1987, three in 1988, two in 1989, one in 1990 and none in 1991.
The prospective study identified 256 women who said they had self-induced an abortion, 100 using misoprostol and 110 using other methods, while 46 said they had used other drugs or herbal infusions. The proportion of women who presented with fever, urinary tract infection and/or genital trauma was statistically significantly less among those who had used misoprostol than those who had used other methods (Table 1). There was no statistically significant difference in the proportion of women with low haemoglobin concentrations.
The doses of misoprostol used were adequate to induce an abortion in all cases and in only a few cases the dose was above the amount needed and could have caused complications, particularly if used to induce second-trimester abortion.
Sales of misoprostol increased about three-fold from 1987-88 to 1989-91, coinciding with a reduction in the number of abortion-related maternal deaths, although the numbers were too small to achieve significance. The study also showed that women who used misoprostol to induce clandestine abortions had significantly fewer complications than those who used other methods clandestinely. (2)
(1.) Faundes A, Santos LC, Carvalho M, et al. Post-abortion complications after interruption of pregnancy with misoprostol. Advances in Contraception 1996;12:1-9.
(2.) Viggiano, MGC, Faundes A, Borges AL, et al. Availability of misoprostol and complications of induced abortion in Goiana, Brazil. Jornal Brasileiro de Ginecologia 1996:106(3):55-61. (Summarised in English by Anibal Faundes)
Table 1. Percentage of women with selected abortion complications, according to method of pregnancy termination, 1994 Number (%) Misoprostol Other Other p (n=100) drugs methods /infusions (n=110) (n=46) Fever 8 (8.0) 8(17.4) 40 (36.4) 0.0000 Urinary tract infection 9 (9.0) 7 (15.2) 33 (30.0) 0.00043 Genital trauma 2 (2.0) 4 (8.7) 5 (4.5) 0.177 Hb below 10g 37 (37.0) 18 (39.1) 46 (41.8) 0.787
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