Oral Misoprostol vs Manual Vacuum Aspiration (MVA) for the m
A recent study suggests that misoprostol is better than manual vacuum aspiration (MVA) for the management of incomplete abortion. It was published in the Indian Journal of Obstetrics and Gynecology Research.

Approximately one in five recognized pregnancies are spontaneously miscarried in the first trimester and an additional 22% end in induced abortion. Incomplete abortion occurs when there are retained products of conception (POC) after induced abortion or after spontaneous abortion, also known as a miscarriage. Some women may resort to self-induction.

A total of 160 women were randomized to either a single dose of 600 micrograms of oral misoprostol or MVA.

--When the women who returned for follow-up at 1–2 weeks were analyzed, 92.45% of women assigned to misoprostol and 95.8% of women assigned to MVA had a completed abortion.

--4 women in the misoprostol group and 1 in the manual vacuum aspiration group required an additional re-evacuation of the uterus after the initial treatment.

--The rate of complications was higher in the MVA group. In that group, 3 women experienced bleeding from cervical trauma during treatment, and 6 women had a pelvic infection at follow-up. In the misoprostol group, only 5 women experienced a complication.

--Bleeding ranged from mild, for about two-thirds of women, to moderate for another third.

--Women in the MVA group rated their pain significantly higher than those receiving misoprostol, only 20% in the misoprostol group have experienced moderate to severe pain, as compared to 41.25% in the MVA group.

--With women in the misoprostol group rating their bleeding significantly greater than those receiving manual vacuum aspiration.

--Regardless of the treatment they received, 70-80% of women indicated that they were either “very satisfied” or “satisfied” with their experience.

For treatment of first-trimester uncomplicated incomplete abortion, both manual vacuum aspiration and 600 mg oral misoprostol are safe, effective, and acceptable treatments. However, misoprostol appears to be a somewhat better option than MVA, in regards to availability, low cost of therapy, less pain, less need for expert manpower or specialized instruments.

Source: https://doi.org/10.18231/j.ijogr.2021.004
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