Vaginal misoprostol alone for medical abortion up to 9 weeks of gestation:efficacy and acceptability

Misoprostol and mifepristone have been shown to be effective for medical ab ortion up to 9 weeks of gestation. When used alone, the successful complete abortion rate dropped to similar to 60%. It has been demonstrated that by adding water to misoprostol, the success rate rose to 92%. This is the firs t randomized study to investigate the efficacy of misoprostol and water ver sus misoprostol alone for first trimester medical abortion in women at less than or equal to 9 weeks of gestation. Eighty women were randomly assigned to group I (water added to misoprostol) and group 2 (misoprostol alone). V aginal misoprostol 800 mu g was given on days 1, 3 and 5. If the woman did not require vacuum aspiration during the period up to the return of first m enstruation after medical abortion, the outcome was classified as complete abortion. The incidence of side-effects and the acceptability were assessed through a standardized questionnaire during and after the abortion. The co mplete abortion rate appeared higher when water was added but the differenc e did not reach statistical significance. Gastrointestinal side-effects wer e common but well tolerated in both groups. Overall, 40% of the women prefe rred a surgical method in the future because of the high failure rate. With an overall complete abortion rate of 85%, it is probably not a clinically acceptable method even if the addition of water can improve the results. We conclude that the addition of water onto misoprostol tablets does not impr ove its efficacy in first trimester medical abortion. Misoprostol alone is not recommended for medical abortion (up to 9 weeks of pregnancy) because o f the high failure rate and low acceptability.